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EHR Outcomes Not All That Great

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I know many of us have been out practicing prior to the switch to EHR and have endured the often painful process of learning curves during the transition.

I've embraced the digital age with enthusiasm but am finding that EHR negatively impacts my daily work flow and productivity and actually does very little to add to the quality of patient care.


I'm a new user on EPIC and cannot believe the complexity of this system that is being used by so many large institutions.


It's affirming to know that so many others find EHRs a difficult hurdle in patient care. It's disappointing to discover that EHRs are in fact such a cause of stress for many of us in healthcare.

HealthCare IT News

Whereas it's relatively safe to generalize that most technologies improve with each new iteration and user feedback yields changes that customers ultimately appreciate, one has to wonder if today's crop of electronic health records software are among the exceptions to that pattern of progress.


Yes, the top-tier EHR vendors are for the most part improving certain aspects of their products, notably usability, workflow, UI, load and response times as well as other features designed to improve both the user experience and productivity. 

But do the clinicians, physicians, nurses and specialists actually using the software like EHRs any more than they did five years ago?

No, they do not, at least according to the results of a study published by the American Medical Association and the American College of Physicians' AmericanEHR division.

Physicians, rather, have are grown increasingly dissatisfied with their electronic health records software during the last five years. 


"While EHR systems have the promise of improving patient care and practice efficiency, we are not yet seeing those effects," said Shari Erickson, vice president of American College of Physicians

The survey, "Physician Use of EHR Systems 2014," found that about half of all respondents reported a negative impact in response to questions about how their EHR system improved costs, efficiency or productivity, the American Academy of Physicians reported.

What's more, the majority of respondents said they were dissatisfied with their EHR system, in fact, and only 22 percent indicated they were satisfied. That percentage dropped down to 12 when asked if they were "very satisfied."

In striking contrast, a similar study conducted by AmericanEHR five years ago found the majority of respondents satisfied – with 39 percent answering satisfied and 22 percent saying they were very satisfied.  

That said, for a little perspective it's important to understand the EHR landscape five years back. The HITECH Act and its incentives for hospitals to implement the software and for EHR makers to meet certain criteria were nascent. Adoption rates have skyrocketed since then, however, and the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT have disbursed more than $30 billion under meaningful use

Given that, what accounts for clinicians being less satisfied with EHRs than they were before all the incentives even began? Was it just a matter of not having pressure to use the software after a fashion that meets federal criteria? Or is this a case of expectation adjustments such that five years ago doctors were happier with less sophisticated technology than they are today? 



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So what?  The customers of EHRs are not the clinicians.  We (and Physicians and NPs and nurses and pharmacists...) are probably 5th in line.


* The government gets population wide data on everyone. Yes, yes, there are intermediate steps and data exchanges and whatnot, but EHRs are the only way to build a countrywide database of all America's residents equivalent to what European countries have.

* The insurers.  They want any excuse to deny anything, and data mining and machine learning will give them a great advantage here to pay less for care.

* The lawyers.  Document? Didn't document?  Why bother with any depositions or other testimony when they can just subpoena the records and hash out a settlement, all the while getting paid like they actually were going to trial.

* The credentialing staff.  You say you did X number of Y procedure?  Let's just look that up, and track the outcomes, and...


You can argue who goes where, but clinical safety and efficacy aren't a big driver of EHR adoption.  If there is any benefit, it's an afterthought, regardless of what is stated about the reasons for adoption.

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We are starting our third EHR. We went from free (practice fusion) to whistles and bells ( Glostream ) and now to Kareo (cheap).  Glostream was a total disaster because they required us to use their billing software. Their billing software was very, very complex and lost 10s of thousands of dollars in claims. We are starting a lawsuit against them as they demand that we keep paying for their product for 1 1/2 more years even though we no longer use it. That company is bound to fail.


Over all, EHRs have cost us a huge amount of money and time.  I opted out of the meaningful use because PAs were totally ignored (we have the stick but no carrot).  If I were to start over, I would have opted out of meaningful use from the beginning, used some simple Rx program and used paper charts. We would be doing well at this point if we had.

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Over all, EHRs have cost us a huge amount of money and time.  


This pretty much sums up my opinion of EMRs also.

That $30 billion investment could provide a lot of health services and programs throughout the country...yet.. we continue to ignore the fact that more administrative costs do not equate to better patient care outcomes.

As a newbie on EPIC I have been asked how I like using it .

My reply is that it's a lot like entering Home Depot to find just one item..... searching to find the right aisle, then having to filter through all the other products selections to find the desired item and make sure it fits the required specifications, taking that one item to check out to find that purchasing one item requires other information about the customer in order to generate a receipt of the transaction. The purchase can be delayed without the proper digital code and everything comes to a screeching halt in the process if there are any issue with the computers which results in a major inconvenience to all parties involved in the purchase.

The single act of one purchase is influenced by too many other hoops and hurdles for the customer! 

Our belief that digitalization has made our lives easier really isn't valid in so many realms including medicine.


It is what it is and EMR is here to stay....hopefully in 5 years there will be significant gains in providing clinicians with programs that actually help us do our jobs more efficiently.

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...hopefully in 5 years there will be significant gains in providing clinicians with programs that actually help us do our jobs more efficiently.

It's been getting better, slower than appropriate, and at greater expense than necessary, but one of the good things about the decrease in average age of new PA graduates is that most of them have been using computers as long as they have been walking.

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I've been using EMRs since 2001 and none is as good as paper or dictation. even after 14 years of experience with epic it still cuts my productivity 40-50% vs paper or dictation and makes me dread coming to work. one of the reasons I like working elsewhere (one of many) is that my other jobs use cerner, which I feel is far superior and much more user friendly, at least for ER applications. I learned the system in 1 day and after 2 years am much more competent with it than I am with epic.

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I, too, have used EMRs since the 2000ish timeframe. 


EMRs are contributing more than a lot of other issues to the death of the ART of medicine and the practice of good medicine involving the patient.


The first one I used in an ER was obviously written by bean counters and you had to pick the acuity before starting - basically pick if this was a 99202, 99203, 99213, 99214 or whatever before even starting the chart. It then locked you into parameters that HAD to be met to meet the billing code. It would allow you to choose a hernia on a finger and had no out for when your "indigestion" in Fast Track turned into a full code cardiac workup or the patient coded……… There was no up or down coding once you started the chart. I made 12 hour shift miserable.


I was part of a go-live in a multi specialty clinic with Centricity and, in retrospect, it is now my favorite. The corp med mentality did not allow for ANY preloading - so every patient was a blank slate - nice because I could put stuff in MY way BUT I got no scheduling support or leniency for production based on a patient being seen with paper chart labeled III of V and I and II are nowhere to be found much less IV or V. The fully expected FP providers to see their quota of all comers and still get all this done by the end of the day.


Centricity was, however, better down the line and I appreciated its style.


Allscripts is by far the winner of the WHY I WOULD QUIT MY JOB AND FLIP BURGERS award. What a piece of horse dung. Clunky, unintelligent, awkward, time wasting, no common sense and the overwhelming ability to make over 600 clicks JUST to get through a basic office visit on a strep throat patient. I won't even go into what it looked like for an internal med type patient with problem lists extending to the 9's. The non-profit who used it REQUIRED providers to click through exams instead of free texting in order to gain Meaningless Use points. Then they went all Medical Home and the whole click for drug education, click for the Treatment Plan and click for this and click for that became a cause for an ulcer and more grey hairs and a general distaste for medicine.


The specialists I referred to also hated Allscripts as the notes were "bland" "non descriptive" and "not helpful". You could click through two patients with strep throat or even HTN and DM and they would come out looking faceless and nearly identical despite one patient having chest pain and the other not or one with a peritonsillar abscess and one with garden variety strep. The only area to expound on your findings was the PLAN section and there I clicked free text and went to town. My specialists all started telling me they would ignore the first 3 pages and go straight to my plan to get to the gist of the whole issue.


Then Epic came into my life. Meh, could be worse - could distinctly be 1000 times better. Another bean counter, data mining debacle full of mysterious ways to accomplish absolutely NOTHING. Another 4-5 pages of printed drivel of debatable quality and dearth of information. We were allowed to free text exam findings - thus, I was once again able to describe "obstructive kissing tonsils with purulent pockets of foul smelling exudate without stridor" instead of clicking a million little stupid boxes that said "tonsillar hypertrophy with erythema".  I was able to give my specialists and referrals a sense of the patient as a person and personality instead of little boxes of information that include archaic terms such as "well nourished" and "lumbago".


Now, I am on Greenway Intergy and finding that they too have missed the ART of medicine boat. It doesn't get along with Dragon Medically Speaking very well and it actually likes OLD computers with &hitty graphics - the new computer doesn't get along with it and makes the screen show a font that would require a level of reading glasses that does not exist. I am old but not that old and seriously - If I can't read the screen - what is the f'ing point? It also doesn't help calculate med doses for peds or do a very good job on med interactions but it sure wants to know what the insurance is so it can check the formulary - hmmmm, allergies vs formulary - which one could I kill the patient with?…….


I learned to take a history on paper with a pen in a certain order and have done it that way for 25 years. I can write admit orders with my old mnemonic ADCVANDISSML, etc etc etc.

I can hand type a full H&P in a fraction of the time it takes to click through some nebulous boxes.

I do not take the computer into the room with me at this time unless I am using google images for educational pictures and Mayo Clinic printouts. I take hand written notes and actually make EYE CONTACT with my patient while taking their history.


Thankfully, I can do this and will continue to do so until the powers that be in the admin world of Medicare and insurance catch me and punish me accordingly. I use eScribe and I do all the meaningless use crap like smoking and stuff because it MATTERS TO ME not the govt.


I leave the room and enter everything into the computer the way I want it and have made Dragon work to my advantage so as to prevent CTS and chronic tendonitis. I use an older laptop that has graphics I can fricking read and I still somehow managed to get paid my few nickels for seeing a patient.


I can only hope that there is a future.


President Obama has at LEAST 3 PAs on his personal healthcare team. My current power trip dream is to have Obama sit with a run-of-the-mill PA in FP somewhere and watch what we go through to take care of patient - someone like his mother-in-law perhaps and that MIGHT make a inkling of difference as to how he perceives healthcare. He has PAs making sure he is a healthy leader - wish we could extend that to everyone else…….


Off the soapbox - 


my very old 2 cents……..

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We are using Allscripts for Psych. If the patient is good, no changes need to be made it works great. If the patient is worse (which is often the case then the system is not very good.

It seems like every week we are having to add more things that we have to click, check and update. I am in my second year after graduation and still working the first job I decided to take as a PA. It is not my first experience with EHR, as a navy corpsman we used AHLTA.  On rotations we used EPIC, Greenway and one of the free ones which I can't recall the name.

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I'm using NextGen which is the most cumbersome time consuming POS on the planet. It was picked y our administration with no input from health care because we are a Community Health Service Agency and it was supposed to provide all the reports they need for all their grants and mess. It didn't, still doesn't, and we are still pouring money we don't have into it trying to make it work. When I suggested jettisoning it I got the "you don't get the big picture" speech. Non linear, non intuitive, time suck.

I used Allscripts several years ago and liked it because it was tabbed like a problem oriented medical record and everything could be customized to the providers individual likes and dislikes. I recently had to use it at an urgent care center while I was moonlighting and found it to have become another giant dense difficult piece of software.

EHRs are like my last several presidential elections.... I just have to try and pick the one I hate the least.

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