The upside of EHRs: 3 physicians' perspectives on what they get right

EHRs are healthcare's most popular punching bags. Physicians say the clunky, unintuitive interfaces make their jobs harder. The cost of implementation ranges from hundreds of thousands to millions of dollars, with some systems even planning for $1 billion-plus. Patients also have a problem with EHRs: The more time the physician spends entering data and looking at a screen, the less satisfied patients become, studies suggest.

With complaints as rich as these, it's easy to overlook the good EHRs facilitate. Here are three perspectives from physicians on what EHRs have gotten right.

Note: Responses have been edited for clarity, style and length.

Jesse Ehrenfeld, MD
Associate Professor of Anesthesiology, Surgery, Biomedical Informatics and Health Policy at Vanderbilt University School of Medicine (Nashville, Tenn.)
Board Trustee for the American Medical Association (Chicago)
"EHRs are obviously here to stay for a lot of reasons, and there are certainly very positive things about them. I think about the things they let me do very effectively, and the things I think most practices around the country that have adopted them find useful. Primarily, they fall into three categories. I think there have been a lot of benefits around e-prescribing. Secondly, some of the drug alerts and clinical decision support built into EHRs have helped us improve quality and safety. Then the ability of multiple clinicians or users to access medical information at the same time. These are probably some of the biggest benefits that, across specialties and practices, physicians find really helpful.

In the operating room, when I have a patient who is under anesthesia, the electronic record gives me a visual representation that allows me deeper insight into what's happening in the moment. When I talk to my colleagues that have clinic-based practices, they find the same thing. Having a longitudinal view of data that's pulled together in a way that generates information is probably a huge benefit of these systems. The challenge, of course, is doing that right and well. The AMA has laid out principles around how these things can be best done, and one of the principles is these systems should help reduce cognitive workload and get better insight from information in the patient's record."

Anas Daghestani, MD
Internist at Austin (Texas) Regional Clinic
"We've pulled all of the clinical data out of our EHR and combined it with claims data from insurance. That allowed us to have more of a complete picture about what happens within and outside our system. We then looked at our population to see how we compared to the National Committee for Quality Assurance guidelines on different health measures, like cancer screening, management of diabetes and management of coronary artery disease. That allows us to look for areas where we're doing better and worse, and devote resources, education and awareness on a system level. At the individual level, we've built alerts within the system to alert our physicians at the time of the [patient] visit. So if I have a patient seeing me for an ankle sprain, but they haven't had a colon cancer screening test done in 10 years and they're due for one, it's going to give me an alert within the system.

We've built those same alerts on the patient side. Our patients have access to our portals, so we've invested a lot of time and energy into promoting access to our system on the patient or customer side so they can log in and see this information the same way we're seeing it. If I'm a patient at Austin Regional Clinic and I log in, it will show that I'm due for a pneumonia shot or a flu shot, that I'm overdue for a mammogram or a colonscopy or a blood test. Making that information available to the patient on an individual level and the physician on a system level measures how we're doing between different providers, different locations and on a population level. We can then decide how we want to invest our resources.

We saw we were having a hard time with screening diabetic [patients] for eye disease. [Screening] rates were low. We looked at national rates and we found them to be as low as ours, so we invested in technology and solutions. We ended up bringing screening equipment in-house, so screenings could be done in the lab at the same time that a patient gets a blood test. We began seeing a dramatic improvement in our screening rate immediately. Before the EHR, we would have not been able to measure that information."

Monica Williams-Murphy, MD
Emergency Medicine Physician at Huntsville (Ala.) Hospital
"EHRs are going to be part of the solution for having accessible and actionable advance directives. Medical care can be driven by wisely considered patient wishes, particularly near the end of life when patients are often unable to speak for themselves. The era of paper records and paper-based living wills [or] advance care plans will hopefully, sooner rather than later, give way to a much more cohesive care plan informed by patient wishes."

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