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EHRs Rush in Where Doctors Fear to Tread

Scott Mace, for HealthLeaders Media, March 21, 2013

Still, continuing resistance should be a wake-up call to technology vendors to make rapid improvements in the quality and usability of their products, say some physician critics.

"The health IT industry needs to be transformed into a quality- and evidence-driven industry, not a purely profit-driven, unregulated free-for-all, where, in my view, hospitals are used as beta testing," says Scot Silverstein, MD, adjunct professor of healthcare informatics at Drexel University in Philadelphia.

That concern is echoed at the highest levels of healthcare. "Many of these [EMR] technologies are not yet very well designed," says Dawn Milliner MD, chief medical information officer at the Mayo Clinic, the 4,000-physician, 70-hospital system. "They're not very intuitive. Physicians work very hard. They do rapid, constant work, day in, day out, night in, night out, that requires a lot of concentration, a lot of effort, interacting with the patient and the record, if not simultaneously almost simultaneously, and when things are clumsy or cumbersome or take longer than old conventional methods, it's understandable that physicians get frustrated," Milliner says.

Silverstein also notes how doctors deal with less-than-ideal technology. "Physicians, being pragmatists, they get this IT thrown in front of them that's designed as if it's for maintenance of widgets in a warehouse, and they say, ‘This stuff's awful, slows me down, I can't find what I need, it's a lot harder to use than paper,' and so they may have been very skeptical." He cites a 2012 report from the Institute of Medicine saying that the magnitude of risk from health IT remains unknown.

Yet for every note of criticism, there seems to be a success story. Mercy Health—a 31-hospital system based in Chesterfield, Mo., that serves communities in Missouri, Kansas, Oklahoma, and Arkansas—completed its transition to electronic health records in a five-year period by emphasizing the standardization of care that technology brings to the organization, says William Walker, MD, chief quality and safety officer.

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