Atul Gawande: Why physicians hate EHR software

In his first article for The New Yorker since being named the CEO of Amazon, Berkshire Hathaway and JPMorgan Chase's joint health venture in June, Atul Gawande, MD, discusses the issues he faced during his own hospital's transition to Epic.

In his most recent essay, "Why Doctors Hate Their Computers," Dr. Gawande, a surgeon at Boston-based Brigham and Women's Hospital, explores his experience with the hospital's switch to Epic's EHR system — a conversion that took place in 2015 across Boston-based Partners Healthcare's 12 hospitals, including Brigham and Women's, and hundreds of clinics. The upgrade, Dr. Gawande notes, cost the health system roughly $1.6 billion and aimed to keep providers technologically up to date.

However, three years after the update, Dr. Gawande writes the Epic system "that promised to increase my mastery over my work has, instead, increased my work's mastery over me" — a sentiment that he acknowledges is shared by providers nationwide. The use of such systems has drastically cut the amount of time physicians spend with patients and increased their average workday to almost 11.5 hours.

"Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we've reached a point where people in the medical profession actively, viscerally, volubly hate their computers," he writes.

During the first phase of the go-live at Brigham and Women's in May 2015, the hospital reduced the number of admissions and appointments for two weeks as staff navigated the new system. For another two weeks, Dr. Gawande said his department doubled the time allocated for appointments and procedures to accommodate the learning curve.

"As I observed more of my colleagues, I began to see the insidious ways that the software changed how people work together. They'd become more disconnected; less likely to see and help one another, and often less able to," Dr. Gawande writes. "Medicine is a complex adaptive system: It is made up of many interconnected, multilayered parts and it is meant to evolve with time and changing conditions. Software is not. It is complex, but it does not adapt. That is the heart of the problem for its users, us humans."

However, Gregg Meyer, MD, COO of Partners, told Dr. Gawande he views providers' frustrations with the implementation as stemming from a fundamental misunderstanding of who the new system is supposed to benefit most: patients.

"We think of this as a system for us and it's not. It is for the patients," Dr. Meyer said, adding that while some 60,000 staff members at Partners use the system, almost 10 times as many patients log in to the system to view their medication history, lab results and other medical information.

"I'm playing the long game. I have full faith that all that stuff is just going to get better with time," Dr. Meyer said.

To access Dr. Gawande's full article, click here.

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