The American Medical Association gives physicians a platform to air their grievances about electronic health records systems, but the technology is here to stay, says an executive with the College of Healthcare Information Management.
Longstanding physician dissatisfaction over electronic health record systems, Meaningful Use, and the federal regulations behind them lit up a town hall-style meeting Monday night, hosted in Atlanta by the American Medical Association and the Medical Association of Georgia and webcast live.
Rep. Tom Price, MD, (R-GA), formerly medical director of the orthopedic clinic at Grady Memorial Hospital in Atlanta and co-host of the town hall kicked things off with one specific complaint of doctors, "inconsistency is a problem." The event was part of the AMA's Break the Red Tape campaign, which aims to postpone the finalization of MU Stage 3 regulations.
AMA President Steven J. Stack, MD, told attendees that the meeting was an opportunity for them to be heard. "This is not for you to hear me talking to you, but for me to hear you talking to me... Has workflow in your office changed?" he goaded the crowd. At least 80% raised their hands. A sole hand remained raised when Stack asked if the change was for the better.
Almost immediately, physicians gave voice to the barriers to care they say are caused by electronic health records systems. Over the course of the 90-minute meeting they raised concerns over reduced productivity, the security of private patient medical records, interoperability, and government regulation.
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"We're removing the science from medicine," said one physician who described having to check "yes" and "no" boxes rather than being able to note subtle nuances his patients reported.
"Thank God I learned to type in high school—I never thought I'd use it," said another, explaining that she now has to make sure every employee she hires can type, regardless of the job for which they are hired.
Some physicians tweeted their frustrations during the meeting, using the hashtag #fixEHR.
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Point of No Return
Physicians' experiences with EHRs vary widely, says Bill Bria, MD, executive vice president of medical informatics and patient safety at CHIME, (the College of Healthcare Information Management.) "An EHR is complete patient information, right there, whenever you need it, wherever you need it," he said by phone hours before the town hall.
Being able to find detailed patient records in just a few moments without digging through files, calling the pharmacist to check a prescription history, or attempting to rely on memory is far superior to the alternatives, he argues.
"We're not going back to the paper age," says Bria. "That era is over."
Ann Shepard, RN, vice president and chief informatics officer at Colorado-based Catholic Health Initiatives, in an interview Monday afternoon, said she generally agrees with Bria—and even that the federal push to implement an EHR has benefitted CHI, even though its implementation has not been seamless.
Shepard compares CHI's experience to building a house. "We're getting there… you have to first build out a firm foundation, which is what we've been doing. And I'd say that we're in a good place. This has not been a negative experience for us."
"Meaningful Use was a significant driver for us and our EHR adoption. Before the HITEC Act, we were using a combination of paper files and just minimal electronic records, but legislation pushed us a little faster than we were going."
Pointing to BCMA as an example—a barcoding of medicine administration system—Shepard says that certain innovations nurses now rely on would not be possible without EHRs. "It's allowed for enhanced patient safety... When a busy nurse goes to the medicine cabinet, she's usually trying to remember what she's already given out, the dose, the route, what she still has to give out that day—and there are opportunities for error in those situations. No one ever means to make a mistake, but it happens," she says.
With BCMA, nurses have the ability to build in safety checks. A barcode on the patient's bracelet helps keep track of which meds are due to the patient at what time, and the right dose, all while double checking that this is the correct patient.
"These and other innovations that utilize EHR systems decrease errors that cause harm to patients," says Shepard.
Breakdowns in EHR implementation and design do happen, Bria concedes. "Usually, when I see an organization having problems with EHRs, it's because they're configured inappropriately," he says. "EHRs should be in complement to the office's workflow. But sometimes… there are inappropriate settings, and they become interruptive." This can be caused by treating them as though they are "only billing machines" rather than clinical tools. Anyone in that situation should consider reconfiguring their system, he says.
While the physicians attending Monday's town hall made their dissatisfaction clear, Bria feels strongly that it's too late to reverse the EHR trend—and high time physicians embraced it. "It's just a cost of doing business," he says.
Lena J. Weiner is an associate editor at HealthLeaders Media.