Training Day

Screen Shot 2015-04-06 at 7.20.19 PMDr. Samuels’ day-long training experience is unfortunate, but it’s only the opening chords of a much longer symphony of time commitments required by electronic medical records (EHRs).  Many studies document the extra time that EHRs impose on doctors and patients. Research in U.S. hospitals and medical offices suggest that these systems can add a half-hour or much more time to a day. A study by McDonald et al (2013 JAMA Internal Medicine) found EHRs added 48 minutes/day to ambulatory physicians, and Hill et al found that in a large  community hospital emergency room 43% of all physician time was spent entering data into the EHR. This almost doubled the time spent caring for patients, and tripled the time needed to interpret tests and records. (Annals of Emergency Medicine, 2014).

Some of that extra time is spent with clunky interfaces and  hide-n-go seeking for information that should be immediately available, such as arbitrary or unexpected  presentations of data, e.g., having to find a patient’s history by clicking on her current room number, or lab reports that may be arranged by chronology, by reverse chronology, by the lab company, by the organ system, by who ordered them, or by some informal heading, such as “blood work” or “tests” or “labs.”  Then there’s the constant box clicking (or what clinicians call “clickarrhea”).  EHRs also send thousands of usually irrelevant alerts that desensitize doctors to legitimate clinical recommendations.

Equally important, we must ask how this extra time and frustration affects medical errors and clinician dissatisfaction.  While EHRs offer myriad advantages and will contribute to improved patient care in the future, we should learn from the disadvantages to make the technology even better and less burdensome. Enthusiasts in the industry and in government focus almost entirely on the benefits and downplay the problems—a foolish strategy for patients, clinicians and the industry itself.  (Do we only learn from our successes?)  We have spent trillions of dollars on these systems that are generally non-interoperable and don’t even have one standard data structure.

Ross Koppel is a sociologist at the University of Pennsylvania. Stephen Soumerai is a professor at Harvard Medical School.