Praise, criticism & everything in between: 14 physicians sound off on EHRs

What is the first thing that comes to mind when you think about EHRs? Becker's Hospital Review asked physicians to share their thoughts on the EHR user experience and where these systems fit in the future of healthcare. Responses ranged from frustration and resignation to applause and hopefulness. Here are thoughts from 14 physicians working in various areas of the healthcare industry.

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

Graham Abra, MD, Director, Medical Clinical Affairs, Satellite Healthcare (San Jose, Calif.).

On the value of specialty-specific EHRs: "One of the pitfalls of many EHRs is that they are built to serve many users, so a platform built specifically for nephrologists is refreshing to use. As a referring physician I actually enjoy using SPIN MD and SPIN MD Mobile from Satellite Healthcare. SPIN MD is accessible online and SPIN MD Mobile is available for both iPhone and Android platforms."

Ingrid Gerbino, MD, Internist, Virginia Mason Institute (Seattle).

On EHRs and patient safety: "EHRs have improved patient safety and patient care by leaps and bounds. They are patient-centric, they foster a team approach, they promote team communication and they embed quality and safety into care. With EHRs there are no more lost test results, lost reports or missed handoffs. All pieces of the record are visible to the entire team."

On IT and clinical leaders working together: "When a care team and IT work in silos, the programmers' finished products often don't work well for the care team. When providers and IT work together during the intensity of an improvement event, the programmer understands the care team's goals, and the care team understands the EHR software's capabilities and limitations. By collaborating during improvement events, the team and IT create better, safer and more useful EHRs together."

Joseph Glaser, MD, Radiologic Associates (Middletown, N.Y.).

On EHRs and information flow: "In my specialty of diagnostic imaging, there is less direct patient or head-to-head physician contact compared with what may be seen with other specialties. EHRs have been instrumental in facilitating rapid flow of patient information to help patient care. Ensuring that information can be gathered and flows seamlessly requires close collaboration with other clinicians, as well as expert technical, information technology and IT specialists."

Doug Hansen, MD, Altitude Family and Internal Medicine (Lakewood, Colo.).

On EHRs and physician independence: "My practice has grown to seven providers in less than 10 years, and I am planning to grow to 10 or more in the next few years. To stay independent and do things my way I need solutions that are flexible, integrated and mobile. We initially started with a client-server EHR. However, we found that it did not meet our needs in terms of speed and efficiency. In 2014, we switched to Kareo's cloud-based solution and the results were night and day. We found that having a cloud-based system that is dedicated to the way independent practices work is key."

Bruce Hensel, MD, Chief Medical Correspondent, NBC4 (Los Angeles).

On EHRs' potential: "Electronic health records were very difficult to institute because they were a whole new way of operating for many providers. However, when used properly they save time, reduce risk and have the potential to improve patient satisfaction."

Howard Marcus, MD, Austin (Texas) Regional Clinic.

On EHRs and patient safety: "While there is great value to using EHRs, I became more aware of potential patient safety issues when I reviewed the results of a study of closed malpractice claims in which EHRs were a contributing factor.  The study was conducted by The Doctors Company, a medical malpractice insurer, and provided recommendations on actions physicians can take to enhance patient safety when using EHRs. For example, we can minimize use of the copy/paste function, be vigilant when using templates, and familiarize ourselves with the design of the system so we don't miss important clinical information such as results from lab and imaging studies."

Angus Matheson, MD, Family Medicine Physician (Willits, Calif.).

On finding an EHR that works for a practice: "My understanding is that most clinics' [productivity] decreases by about 25 percent initially, only to rise to a drop of about 10 percent when an EMR is implemented. I have loved using Practice Fusion. Since we started using it our productivity actually went up and doctors are seeing more patients."

David J. Mathison, MD, Mid-Atlantic Regional Medical Director, PM Pediatrics (Lake Success, N.Y.).

On learning how EHRs fit into workflow: "EHRs are critically important to improve information sharing and quality care; however, this is often at the expense of decreased efficiency and often reduced direct patient-to-physician interaction. In the emergency department and urgent care setting, efficiency is paramount, so it is an ongoing learning process to effectively use an EHR without negatively impacting clinical workflow."

Ann Negrin, MD, Ophthalmologist (Mount Kisco, N.Y.).

On the EHR learning curve: "With [an] EHR there is a big learning curve to get used to the software program. Even then, several times a year software updates meant meetings to go over the new things to learn. [It's] very frustrating, especially for my older colleagues who were not as computer savvy as us younger docs."

On EHRs and human error: "EHRs basically eliminate all of the guesswork. Dates of exams, as well as phone calls, are all correctly recorded, regardless of human error. EHRs also eliminated human error in writing medications, [like] spelling errors that could lead to serious consequences."

Alan Pitt, MD, CMO, Avizia (Reston, Va.).

On EHRs and communication tools: "EHRs are the operating system of today's healthcare. However, like Windows has separate applications that add value, we should expect this to be the road forward with EHRs. In terms of collaboration tools, EHRs tend to offer secure email or embedded video, labeling it telemedicine. Such solutions ignore some of the profound cultural changes brought forth through modern communication tools. Access anywhere is game changing for both patients and providers, but there is a role-based hierarchy in healthcare that needs to be baked into solutions to enable effective telemedicine and medical collaboration."

David A. Rivera, MD, OB/GYN Physician (Lombard, Ill.).

On EHR design: "All EHRs appear to have been designed by administrators, not physicians. No one has ever asked us how we do our work. Understand, I am not a Luddite. I was working with computers in the 1970s, doing all the things the kiddies take for granted (email, chat, instant messaging). EHRs could be incredibly useful, but they are not."

On EHRs versus paper: "The complexity is overwhelming and not conducive to efficiency. It takes me 10 minutes to generate a prescription I could have written on a pad in 10 seconds."

Bruce Ruben, MD, Medical Director, Encompass HealthCare (West Bloomfield, Mich.).

On the loss of patient connection: "Electronic medical records have been difficult in both learning the system and in actually charting. That's because they both take up time. More importantly, when I'm with the patient, I am unable to make constant eye contact because I must keep my eyes on a computer screen while typing, rather than on the patient. When I used to hand write in the chart, I was able to jot down a note or two, and then look up to resume my conversation with the patient. I don't feel as connected to my patients when this happens, and I don't like that aspect. The other choice is to go in another room to then chart after the visit, and this takes up time over the course of a day. Still, the patient connectivity is lost, and that's what's most important to me as a doctor."

Dr. Deepak Thekkoott, Interventional Cardiologist, Medical Director, Director of Interventional Cardiology, Cath Lab Services and Chest Pain Center, Lane Regional Medical Center (Zachary, La.).

On a user-friendly interface: "This system [Objective Medical Systems] is unique in which the application has a friendly user interface that is not cluttered and the workflow navigates well as compared to other systems I have used in the past. It also has allowed me to enhance productivity and quality which is the key when selecting a long term solution for a busy practice."
 
Adam Weinstein, MD, Kidney Health Center of Maryland (Easton).

On positive relations with an EHR vendor: "My practice has used Falcon EHR since 2011. While no physician loves using an electronic health record, we have much of what we can hope for: a good relationship with a responsive, enthusiastic company looking to continually improve its product."

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