As more hospitals move to electronic health records (EHRs), many physicians have started writing about their growing discontent with the new systems. Authors have declared that EHRs are poorly designed, inefficient, lead to over-billing, and are downright dangerous. When my supervising physicians gripe about this, I mainly nod along to avoid conflict. But I have a confession to make: Most physicians currently in training love electronic health records.
I don’t disagree with the arguments my more experienced colleagues make about the limitations of EHRs. I know many of their criticisms are based on experiences that most younger physicians haven’t had, especially with regards to how EHRs affect running a practice. But it doesn’t matter. Because young physicians have embraced EHRs, it guarantees they will flourish moving forward. Why do resident physicians like EHRs? Some argue it is because it is the only thing we know, but I disagree. Despite their flaws, EHRs increasingly allow us to cut back on busywork and focus more on being a better, safer doctor.
There are many great examples of how EHRs have started doing this. They allow us to make templates for notes for the same types of diagnoses, which not only saves time, but also prompts us to garner the same key information for each patient. Likewise, they allow us to create order sets or checklists to ensure that we don’t forget about prophylaxis against DVT’s or a patient allergies when placing orders (similar checklists have been shown to improve patient safety). But for those of us who still remember life pre-EHR, the best example of how EHRs have improved resident physicians’ lives can be understood by their effect on the daily process of taking care of patients in the hospital.
As an ENT surgical resident, each morning, we “round” on our patients to review the medical data from the previous day and examine the patient before forming that day’s plan. Before EHRs, trying to see all of our patients every morning was chaos. On each floor, my team and I would engage in a medical game of “Where’s Waldo” looking for the flimsy three-ring binder that held the patient chart. (And yes, just like in high-school, these binders never closed correctly.) While each nurse’s station had a chart rack, the chart was inevitably hidden in some back room where the last physician had left it. That means 3 minutes of search-and-rescue before we even started reviewing medical data.
Once we found the chart, we would examine a flowsheet to attempt to ascertain our patient’s vitals signs (to see if they had, for example, spiked a fever overnight). The data usually consisted of a graph with X marks scrawled near temperature markings and typically required squinting and using a pen as a ruler to determine if there had been a fever or not. Lastly, we would start the arduous process of translating the hieroglyphics noted in the paper chart to determine what the other consulting physicians had recommended. Often, we would have to page each of those doctors and await a return call to clarify. Because we have to be at the operating room to start our surgeries at a fixed time, every minute fighting with paperwork was one less minute we could spend with the patients. After we consolidated the data and examined the patient, we would quickly scribble our own paper note, which in our rush, often inadvertently looked like a mix of cuneiform and English.
Looking back, paper charts were inefficient and prone to error. Today, I can log in from any internet-enabled computer and access all of my patients’ data in one place. I can check which medications were ordered and which had already been given, view x-rays, reliably read recommendations from other doctors about my patients, and leave legible instructions for the team in a typed note. This doesn’t just save time; it promotes better treatment. The many minutes I was forced to devote to gathering data for my patients can now be spent examining and interacting with my patients or answering questions from their family members.
This is how health care should be. If I can access my banking information and buy groceries through my smartphone, it feels incongruous to conduct medicine in a flimsy three-ring binder from Staples. My generation wants our health care environment to feel consistent with the remainder of our life. Moreover, we want to harness the power of technology to improve health care. We want real-time cost-to-patient data in the home-screen. We want data-interoperability to ensure records can transfer. And we want in-system nationwide opioid-prescription monitoring systems to decrease addiction. Everyone agrees that the current systems need improvement, and I understand that with any new technology, new unforeseen consequences can arise.
Still, EHRs are ingrained in how up-coming physicians practice, and as many authors have predicted, we will be their champions. In fact, I have a number of resident physician colleagues who now consider a hospital system’s EHR to determine where to apply for jobs or seek fellowships after residency. In short, while AMA survey data may show decreasing satisfaction with EHRs amongst physicians, for my generation, it may be that we’re expecting more from EHRs, not that we want to go back.
Note: The author has no financial ties or relationships to any EHR company.
Manan Shah is a physician who blogs at MananMD.com. He can be reached on twitter @mananshahmd.
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