The electronic health record (EHR), a digital replacement for patient information that has been stored on paper since the Greeks, has been touted as the technologic advance that will greatly enhance the quality and efficiency of care. But others believe this technology being imposed on doctors will destroy the doctor-patient relationship, increase costs through billing creep, and slow down the busy physician. Is it the answer to many of our problems or the ruination of our healthcare system? We all know the EHR is neither the savior of the system nor its ruination. It’s a new tool, a disruptive technology that, in the short run is a strong dissatisfier for many providers.
Our system has implemented a fairly robust EHR on the inpatient side, and we are in the process of implementing an EHR for the physician practices that are part of the system. The physicians all understand that recording, storing, and retrieving patient health information electronically is here to stay, but, to put it bluntly, most of them hate it. It has changed the fundamental way they work and most would say that they are working harder and really don’t see much benefit to the patient or to them. Doctors also resent the added cost to their practice of installing and maintaining this technology—as much as $20,000 per doctor per year. So why are we putting millions of dollars into this technology?
First of all, there is clearly a generational divide when it comes to the EHR. Most recently-trained physicians are accustomed to using a computer to record their findings and have learned to relate to the patient at the same time. Those who trained before the advent of this technology are just staying at work longer to enter their notes into the computer. As this new generation of doctors becomes the majority, the noise will subside.
It is clearly too early to evaluate the value of the EHR to patient outcomes. However, we do know that, if implemented correctly, it does facilitate the tracking of progress for groups of patients and the ability to track physician compliance with standards of care, such as routine screenings, for different categories of patients. Prior to the advent of EHRs, we had to rely on claims data for some of this information and it was notoriously inaccurate. The timely availability of accurate information on the status of the patients served by primary or specialty providers is critical to advance the concept of population health. In addition, as we move away from what many have come to see as the perverse incentives of fee-for -service reimbursement to various forms of global payment, the ability to measure outcomes becomes even more critical to guard against the perception of “cutting corners” to reduce overall medical expense.
EHRs, as we know them today, must undergo extensive development to gain broader acceptance. However, we have crossed the digital divide and can’t turn back. It’s now up to the new crop of providers, who understand the underlying technology, to help evolve the EHR into an effective tool for advancing patient care, much as surgeons have learned to use robots and other technology in the operating room.
I look forward to your comments. --Lou Giancola
I came across an article in the New York Times about the Nurse-Family Partnership and thought it might be interesting for those of you who may have missed it—and those who perhaps are unaware that Rhode Island is one of 42 states that has instituted this remarkably successful program. I found it particularly notable, perhaps, because I’m married to a pediatrician. The article, titled “For Mothers at Risk, Someone to Lean On,” profiles the social program in New York City.
