Meanwhile, however, many physicians stumble along, working longer hours to get their visit notes into the EHR. Doctors who sluffed off the initial training are in much worse shape than those who paid attention and tried hard to learn the system, Basch points out. Mature users like himself can document fairly rapidly by using a combination of point and click, typing, and dictation with speech recognition. But physicians who are fairly new to EHRs—a majority of users at this point—may have a lot of trouble keeping up with the flow of information.
Many doctors have developed workarounds. Either they dictate the majority of their notes, which produces a mass of unstructured text, or they copy and paste parts of previous notes into current ones. The latter method not only increases the risk of errors, but also may create the appearance of fraud. And it increases the problem of locating important information later on in the copious, repetitious text while trying to treat patients.
Alerts are out of control
Beyond documentation, EHRs generally include alerts that are supposed to improve quality and safety. These include alerts that pop up when a patient needs recommended preventive or chronic care. Some of those reminders are irrelevant, either because a patient doesn't fit the parameters or because the care was performed elsewhere.
Other alerts go off to prevent adverse drug interactions with other medications, allergies, or foods. Many of these are inapplicable to particular patients, and after a while, doctors may stop paying attention to them or turn them off. Three quarters of EHRs don't allow the customization of these alerts, according to Anderson.
Most EHRs were designed for primary care, so they don't work well for other kinds of specialists, he notes. Some good specialty EHRs exist, but not in all specialties, and those EHRs may not be interfaced with an organization's enterprise system. Epic and Cerner, which make the leading EHRs that cover both hospital and ambulatory care, provide decent templates for inpatient specialists, Anderson says.
Toward a more usable EHR
To save time, Basch would like to have an EHR that can reuse information. That would enable him, for example, to use the data already in the system to populate documents such as prior authorization forms.
He'd also like a "smart" EHR that places information in context. "When I look at a lab result for liver function, I don't just want to see prior results, I want to look at other things if they're elevated," he says. "Show me a med list and show me the meds that the patient is on that could possibly impact liver function. Or show me imaging studies. Because right now I do that manually."
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