Why do doctors hate their computers?
That’s the question that Atul Gawande sought to answer in a recent, thought-provoking article in The New Yorker. Gawande, who is a surgeon with Partners HealthCare, notes that digitization “promises to make medical care easier and more efficient” – and then rhetorically asks if screens are coming between doctors and patients.
As a physician who has worked on several different systems over the years, I am confident that 99 percent of my peers would say that screens are definitely coming between doctors and their patients – and most would add that digitization has largely failed to make it easier for us to efficiently deliver patient care.
Gawande recaps the saga of his hospital system’s EMR implementation and the impact it has had on physician workflows and productivity. In short, he mentions the same complaints that we’ve heard over and over for the last 10 or 15 years: EMRs cost too much, slow physicians down, and provide too few benefits for users. In addition, EMR use contributes to physician burn-out.
To minimize the inefficiencies of EMRs, Gawande observes that some physicians now rely on scribes to enter details of their patient encounters – which is, of course, ironic since EMRs were created to reduce the inefficiencies of paper. One doctor has resorted to hacking into the system to remove “useless functions” and add useful ones, while other physicians have turned to third-party apps that extend the functionality of their EMR without changing the core application.
As I reflect on Gawande’s article, I’m left with several thoughts about EMRs, how EMRs are implemented, and what stakeholders can do to help doctors to feel a little less hate towards their computers.
Physicians need a bigger voice – and they need to be heard
I have observed that larger health systems tend to give physicians less control over their own workflows. Too often workflow is dictated by the decisions of ancillary staff with little regard to the impact on physician productivity.
Gawande shares the story of a longtime office assistant who claims that “each new software system reduced her role and shifted more of her responsibilities onto the doctors.” Previously she would draft letters to patients, prep routine prescriptions and handle other tasks to lighten the doctors’ role. However, with the new EMR, office assistants are not trained or authorized to perform these functions, so doctors must now do it all themselves. If physicians are now responsible for every last mundane task, is it any wonder they are frustrated?
In another example, Gawande relays complaints about the system’s illogical setup. One physician expresses her irritation about mandatory fields that create inefficiencies. Previously she could document a Pap smear in a few short clicks, but now must enter such details as the physician and the date of service – rather than simply defaulting to the doctor entering the note and the current date of service.
The overriding issue here is that many organizations fail to consider how a particular configuration decision will impact its physician users. Rather than optimizing EMRs to enhance physician productivity, administrative users often dictate how various functions should be set up. In order to minimize physician frustrations, clinicians must be given a bigger voice in decisions that impact their workflows.
Physicians are overloaded with data – and much of its not helpful
One of the greatest benefits of an EMR is that all of a patient’s data is stored in a single record. Unfortunately, unless all this data is well-managed, clinicians can end up with blobs and blobs of data that must be weeded through to find usable information.
Case in point: one of Gawande’s colleagues notes that problem lists have “become a hoarder’s stash” because everyone across the organization can modify the lists. Three people may list the same diagnosis in three different ways, making the lists long, deficient and redundant. In addition, because the charts contain so much data, both from internal sources and third-party providers, a clinician must hunt through pages and pages of information to find details that are relevant to a patient’s current issue.
Doctors should not have to go through the time-consuming task of combing through every transaction within a patient’s chart to confirm a suspected diagnosis or make a treatment decision. Instead of overloading clinicians with so much data, organizations need to incorporate solutions that filter the growing volumes of available patient data and create a more streamlined view with only diagnostically-relevant details that support decision-making. Such tools should automatically identify and interpret all the disorganized data within a patient’s chart, then transform that data into clinical insights at the point of care.
Until organizations provide users with such filtering capabilities, physicians will continue to feel overwhelmed with EMR data.
Physicians are demanding new solutions for the same old problems
The biggest benefit of scribes is that they give physicians the freedom to devote their complete attention to patients, rather than the computer screen. But as Gawande points out, they aren’t a perfect solution: physicians still must review the final chart note; physician workloads are not lightened because the time that scribes free up is used to see additional patients; and, it doesn’t necessarily improve overall physician satisfaction.
I believe a more viable solution is to expand the availability of third-party applications so that both clinicians and administrative staff can add new functionality to address their needs. To date, some EHR vendors have been hesitant to open up their systems, fearing a loss of control - and missed revenue opportunities. However, this mindset must change if we ever want physicians to fully embrace EMRs as a productivity-enhancing tool that makes it simpler to deliver quality patient care.
Digitization does promise to make medical care easier and more efficient – but we still have a way to go. By giving physicians more control over their workflows and tools to help navigate mounds of clinical data, we can give doctors more reasons to feel a little less computer-hate – and perhaps even a little computer love.
By Jay Anders, MD, Chief Medical Officer of Medicomp Systems