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The digital doctor: the five 'I's of electronic health records.

It is dear that physicians are not friends of electronic health records. The predominant sentiment is that EHRs are costly (a third of providers are buying their second EHR system) and are poorly functional. Much has been said about their failures. The shortcomings have ranged from lack of cost benefits to interoperability with medical devices and security of that interoperability Decreasing provider productivity and direct patient interaction time are of concern. These opinions were raised in a "Medical Economics" survey and a study by Rand Corporation. Interestingly, physicians do not want to return to paper records. I will discuss what I call "The Five Important 'I's" of EHRs.

1. EHRs are not INTUITIVE. Navigating an EHR is akin to guessing what is behind Door No. 2 of "Let's Make a Deal." Documentation does not follow a provider's thought process or the interaction workflow. It is built to meet regulatory and billing requirements. Many physicians have to learn to be facile with different EHRs if they go to different hospitals. The AMA has called for a design overhaul of EHRs.

2. EHRs are IMPOSING. Providers spend an inordinate amount of time with the EHR and less with patients. Most providers do not receive adequate training, which is inversely related to privacy and security breaches. EHRs are inflexible, and progressive practices with ambitious patient quality initiatives cannot implement them because of information technology issues.

3. EHRs have limited INTEROPERABILITY. At a recent session of the Office of the National Coordinator at the annual conference of the American Health Information Management Association, Chief Science Officer Doug Fridsma laid out an ambitious vision of what he calls the "Learning Healthcare System," which comprises the building blocks of health IT This will result in improved interoperability by way of the system adapting to change with encounters.

4. EHRs need INSIGHTFUL analytics. Data without good analytics are almost useless. Clinical decision support tools make EHRs pertinent insomuch as they can incorporate accepted practice guidelines as well as customized "best practice" decision support. These follow provider workflows and make the tool more intuitive. Add to this proscribing analytics that actually recommend (not prescribe) tests or treatment plans, and one ends up with a physician's friend.

5. EHRs must INCLUDE robust patient portals. These will be critical in creating a true patient-centric health care system. Most portals are proprietary to the customer's EHR vendor because of low cost. There are some excellent third-party portals that can corral data from different providers who might have different EHR vendors.

This list is not inclusive of all EHR issues, but it serves as a focal point for discussion. A sixth "r might be "IMMOBILE." A physician running back and forth to computer stations from patient beds creates self-evident inefficiencies. Available (not offered by most vendors) mobile versions of EHRs have their own drawbacks. The small screen on a smartphone is a severe limitation, though many physicians do use tablets.

As a champion of digital health technologies, I am frustrated about the vision I and many others have for their use. However, as with most technologies (and few have been as disruptive as EHRs), adoption in health care is slow. I look forward to leaders like Doug Fridsma and organizations such as HIMSS, which has excellent representation by clinicians, to help bring about necessary changes.

DLS Healthcare Consulting, Harrisburg, Pa. Scan the QR code for commentaries on internalmedicinenews. corn.


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Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of
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Author:Scher, David Lee
Publication:Internal Medicine News
Date:Oct 15, 2014
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