Why Doctors Don’t Like Electronic Health Records

Why are doctors so slow in implementing electronic health records (EHRs)?

The government has been trying to get doctors to use these systems for some time, but many physicians remain skeptical. In 2004, the Bush administration issued an executive order calling for a universal “interoperable health information” infrastructure and electronic health records for all Americans within 10 years.

And yet, in 2011, only a fraction of doctors use electronic patient records.

In an effort to change that, the Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn’t had much more luck getting physicians to change their ways.

What is wrong with doctors that they cannot be persuaded to adopt these wondrous information systems? Everybody knows, after all, that the Internet and mobile apps, powered by Microsoft, Google, and Apple and spread by Facebook, Twitter, YouTube, and the iPhone and iPod, will improve care and cut costs by connecting everybody in real time and empowering health-care consumers.

I suspect the answer may lie partly in something essayist E. B. White said about humor. “Humor,” said White, “can be dissected as a frog can, but the thing dies in the process, and its innards are discouraging to any but the pure scientific mind.” Similarly, humanity withers when it is dissected and typed into an EHR. As Jerome Groopman, a Harvard internist, wrote in How Doctors Think, “Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment … but they quickly fall apart when doctors need to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact.”

The computer is oversold as a tool to improve health care, implement reform, cut costs, and empower patients. The reasons are obvious to anyone who treats patients. You cannot look a computer in the eye. You cannot read its body language. You cannot talk to an algorithm. You cannot sympathize or empathize with it.

We physicians are not Luddites or troglodytes. We are savvy about using the Internet, technology applications, and social media. For us, medicine mixes art and science. What we seek from patients are clues, constellations of signs and symptoms, and stories. We choose not to be reduced to data-entry clerks sorting through undigested computer bytes.

A string of numbers containing demographic, laboratory, and other patient information, no matter how systematically assembled or gathered, is not narrative. It does not tell a story. It contains “just the facts,” as Sergeant Joe Friday used to say.

That is why an ophthalmologist told me that when he gets an EHR summary, he ignores it: “It does not tell me the patient’s story. It does not tell me why the patient is here, what troubles the patient, and what the referring doctor wants me to do.”

There are also more mundane reasons why physicians, particularly in small practices, do not cater to EHRs or to their private enthusiasts and government backers. EHRs, you may hear physicians argue:

· are sold by so many companies—more than 100 at present—that no one knows how to separate the good from the bad and survivors from non-survivors.
· slow productivity.
· show negative investment returns.
· don’t speak to one another.
· distract from patient time.
· require total reorganization of practices.
· conceal a strategy for monitoring, controlling, and dictating practice activities.
· can be misused or hacked to invade privacy, reveal sensitive information, and threaten the security of patient and doctor alike.
· raise practice costs.

A word on the final point. It is not only the $40,000 that software vendors charge to install an electronic records system and the $10,000 to $15,000 for annual maintenance. It is the hassle factor and the often prohibitive cost of hiring staff to enter the data and to comply with new rules and regulations. When added to the time and effort already required to deal with Medicare, Medicaid, and health insurance plans, EHR requirements are the final straw.

Many doctors are seeking refuge from bureaucratic demands by retiring, closing practices to new Medicare and Medicaid patients, or seeking hospital employment.

This is ironic, since many physicians believe that new apps, such as better speech recognition or systems that translate data into narrative, will make EHRs easier to use. “Free,” government-subsidized, or cheaper models will enter the market; clinical algorithms, based on demographic and patient-entered historical information, will make diagnosis, treatment, and management faster and better.

But these features must evolve from below rather than being imposed from above. EHRs won’t be useful and physician-friendly until physicians themselves have more input into their design.

The digital revolution, and all the improvements in health care that are promised, will remain promises until the EHR is more useful—in medical and economic terms—for doctors.

Richard L. Reece is a retired pathologist and the author of The Health Reform Maze: A Blueprint for Physician Practices. He blogs about health reform, medical innovation, and physician practices at medinnovationblog.

This post first appeared at Technology Review, published by MIT.

Livongo’s Post Ad Banner 728*90

Categories: Physicians

Tagged as: , , ,

Leave a Reply

44 Comment threads
44 Thread replies
Most reacted comment
Hottest comment thread
33 Comment authors
Hogan City Tech UomoNike LunarGlide 4Nike Free 5.0 V4Nike Air Max 2013Jordan Sixty Club Recent comment authors
newest oldest most voted
Hogan City Tech Uomo

Patterson, who loaned himself $200,000 on Dec. 31, has trailed in fundraising. He was surprisingly flush, though, reporting more cash on hand — about $347,000 — than either Staples ($331,000) or Patrick ($168,000). Dewhurst entered the home stretch of the primary with about $581,000 in the bank.

Nike LunarGlide 4

Although Lyari is relatively calm these days, many residents say that the silence is actually an indication of a gathering storm.

Nike Free 5.0 V4

San Diego-based Omnitracs is one of several companies owned by Austin-based investor Vista Equity Partners that would move offices into the KPMG tower,Michael Kors, real estate brokers say.

Nike Air Max 2013

“The poor dog is getting classified according to her looks,” she said.

Jordan Sixty Club

who ruled the Maldi

Mens Nike Free 3.0 V4

The Bank of Canada??s most recent projection, in July,Michael Kors, is for economic growth to accelerate to 2.0 percent this quarter and to keep rising to 2.7 percent in the fourth quarter of 2013.

Nike free 5.0 run outlet

hooray to thatbr

Mens Nike Free Haven 3.0

See below for an excerpt from the website:

Nike Air Max 1

In a perfect world, it would stay there. It won’t.

Jordan 3 + Vol 4 Chaussures

??Most of the police officers know him by name,Michael Kors Handbags,” Margie Morrow said.

Femmes Air Max 2011

As for Wall Street, ,Michael Kors Wallet, as do the . Then again,Michael Kors, just over the weekend we were told that investors were so dang tired of the regular brinksmanship in Washington that they were disinclined to get worked up about this time around.

Nike Air Max BW

This time,Michael Kors Outlet, This incident, not as a Pakistani, but a second Pakistan is definitely in the making. but given the rate at which the population is growing it is anticipated that the same bonus may turn into the undoing of the country; Pakistan runs the risk of imploding under the very weight of its population. These images must be coupled with passionate political activism,Michael Kors Wallet, the tide would turn in favour of Palestinian rights. espousing the case of ordinary folk crushed by unaccountable power and inequality. bringing issues of accountability of executive to the parliament and of… Read more »

Airwair Martens zapatos de mujer

They skyscraper last sold,Michael Kors??in 2006 for an estimated $216 million,Michael Kors Outlet.

Dzięki wystawy medialnej, zielonych ziaren kawusi suplementów strata veight Wyciąg uzyskała serdeczne
przywitanie pośród konsumentów, którzy zmagają się spośród
nadwagą. Jak na przykład nie ulega wątpliwości, nadmiar hołota ścierwa przewodzi aż do długiej listy chorób zagrażających
mieszkaniu, wskutek tego ważne jest, tak aby stanowić

clé windows 7 gratuit

Microsoft office 2010 is a innovative edition that wipl please you with its interface and functionality.
Zalman FTP client 2010 contains an additional feature of
logic layer and therefore every specific action can be tracked.
Thse types of serial killers tend to have below average intelligent levels and are considered to be
socially inadequate; often living alone and someone who does
not date.

My web-site clé windows 7 gratuit