Paper records are here to stay: 4 questions with Illinois Pain Institute's Dr. John Prunskis

Many physicians have reported frustration with EHRs. To address this dilemma, one Midwestern private practice has taken a straightforward approach — removing EHRs altogether.

The majority of physicians report EHRs slow their workflow, according to the Medscape EHR Report 2016, and a 2016 study in Mayo Clinic Proceedings linked EHRs with physician burnout. Physicians even say EHRs have infringed on the quality of their patient interactions, according to a study published in the Journal of Innovation in Health Informatics last month.

John Prunskis, MD, founder and co-medical director of Illinois Pain Institute, which has multiple locations in Lake, Kane, McHenry and DuPage Counties, says these concerns led the practice to consider the overall necessity of EHRs. "We felt the level of patient care was not enhanced by an electronic health record," says Dr. Prunskis, a practicing interventional pain management specialist. "We saw it was inefficient and added nonproductive work to physicians' time."

The Illinois Pain Institute staff made a unanimous decision to return to paper records two years ago, and hasn't looked back since. "We have over 70 employees, so we took a vote to see whether anyone thought the EHR was providing a better patient care experience or a better office experience," he explains. "Not one person in the practice thought we should keep the EHR."

Dr. Prunskis spoke with Becker's Hospital Review about what prompted the practice to revert to paper records and the inherent tension he sees between EHR vendors and practicing physicians.

Editor's note: Responses have been lightly edited for length and clarity. 

Question: How did the EHR impact patient care at the practice?

Dr. John Prunskis: The face-to-face interaction was lost. We felt patients didn't like it, because physicians were typing, instead of looking at them. Now, so many patients tell me, "I am so happy you are dictating in front of me. I'm hearing everything. I'm sick and tired of watching my doctor type onto a screen and not look at me." I honestly believe that's one of the reasons our outcome data is so strong, because while we're dictating, the patient hears what's going into the record. When I'm done dictating, the patient will frequently say, "You know what, doc, there's one more thing," because they've heard what I'm entering into the record and recognize there's something they forgot.

Q: How must EHRs change for Illinois Pain Institute to feel comfortable implementing another system?

JD: No. 1, if we see that it enhances patient care. No. 2, if we see that it does not add extra work for our staff. Everyone talks about evidence-based medicine, but the EHR was launched without enough evidence to support that it improves patient care. The EHR is not a tug-of-war with physicians who are not willing to adopt technology; doctors have traditionally embraced electronics and technology, and were among the first to use electronic pagers, laptops, et cetera. In my opinion, it's a battle between the manufacturers and vendors of the EHR who are reaping huge profits and doctors who are just trying to give patients the best level of care.

Q: How has the move toward EHRs affected hospitals and private practices, like Illinois Pain Institute, differently?

JD: Anybody who's employed by a hospital system, their lips are sealed. They're stuck, because their employer, the hospital, is attempting to meet the requirements for an incentive payment. It's very sad to talk to my primary care colleagues in hospitals, for example, because they're just exhausted. They say it's a disaster, but since most of them work for a hospital, the hospital gets that financial incentive to implement the EHR. They don't get a choice. Primary care physicians are losing hours a day; they're coming home, having dinner, playing with their kids, putting their kids to sleep and then they spend another two to three hours at night doing data entry. It's horrible for them.

Q: Does the use of paper records hinder Illinois Pain Institute's ability to exchange data with other healthcare organizations, like hospitals?

JD: No, all the referring doctors get our notes transmitted however they want them transmitted. Right now, really, the EHR hinders data exchange. One EHR doesn't talk to another EHR, and there's many reasons for that. The other thing is when you dictate a paper note with the relevant clinical findings and history, it's rather succinct, but with the EHR, there's a problem. The EHR is pages and pages of mind-numbing text, where important labs and information can be lost. Before, a note might be a half-page long, but now it can be five, six pages long, and doctors frequently can't find what's relevant through the reams of text and clutter.

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