The EHR should work for us, not us for it

I’m feeling meaningfully used today.

Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested.

An “eligible professional summary” arrives in my email, with lots of bars with lines, and green checks or red Xs. “Incorporate clinical lab test results” must be greater than 55%, “record patient demographics” must be greater than 80%. Scanning the right-hand column, I get a little burst of adrenaline and pleasure for each green mark, and a pit in my stomach for the red ones.

Bad doctor.

Somewhere, somehow, someone decided that reaching these levels of these particular markers were proof that we are utilizing our electronic health record to its fullest potential. Meaningfully using it. And, in turn, that this meant we were using the electronic health record (EHR) to take good care of our patients. And by extension, taking good care of our patients.

A lot of assuming.

Simply using an electronic health record, we are nearly guaranteed many of the meaningful use basic measures. All of our orders are now electronically entered, so this one cannot be less than 100% on an audit. Medications must be reconciled. Vital signs and smoking status are built in hard stops in the EHR, so another win.

But suddenly there’s a new one: P215 — send reminders to patients. And once again I’m that bad doctor. 0% — I have a big red X next to my name. Zero of 1004 patients that the auditing program randomly sampled from my charts.

But wait! How could I send reminders to my patients when that functionality in our electronic health record has not yet been turned on?

A patient of mine who works in health care and knows about this mandate recently sent me the following message through the patient portal, clearly only to help me qualify:

“Hello Dr. Pelzman, I am sending you a MyChart message to meaningfully connect with you. It is a pleasure being your patient! Best, B.”

Well on my way greater than 10%.

Once the “reminders to patients” widget in the EHR gets turned on, we will undoubtedly find a way to quickly and easily reach that required 10% goal.

This, however, is not the point.

We need to get over this anxious desire to please the auditors, and learn to make using an EHR, for us and for our patients, a kinder and gentler experience. A healthy experience. The EHR should work for us, not us for it.

For now we will all continue dutifully clicking the buttons, but all along I want us to keep thinking about how we can use this technology to make health care better. Which patients will benefit from messaging, from getting their labs via email, from getting refills with a click of a button? Many will. Some will not. Some will always need to call, or walk in, or just expect it to happen as if by magic.

Patients are all different, and providers are all different, and how we interact with this new technology needs to be an organic, evolving process, which should not be forced. There is great potential gain in using an EHR, but the answer does not lie in crossing thresholds — rather, it lies in seeing where it will take us.

Hopefully somewhere meaningful.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home

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  • guest

    I am sorry to have to say that you are missing the point here. The goal of meaningful use has nothing to do with tailoring your practice to use technology in ways that benefit individual patients. The goal is to create a standardized practice that could be accomplished by a trained technician without a medical degree. Or better yet, a robot.

    • DeceasedMD1

      I think that is why there is not more of a rebellion with EHR’s: that not enough docs see the destructive nature you are describing and are just using constructive ideas to try make it better.

      • guest

        My impression after 2+years on EPIC is that the last thing our IT department or hospital administration wants to see is me (or any other doc) figuring out ways to make the technology work better for my patients or for myself.

        I have lost track of how many meetings I have attended where I’ve pointed out that “gee, it would be really handy/great for the patient/more efficient/etc/etc if the EMR could do this,” only to get the response that “Well, a PROGRAMMER would have to do that.”

        The unspoken message is: “Please shut up and just spend the extra time clicking away so that you are in compliance with whatever we are interested in having you do. We are really not interested in your ideas, your patients, or your workflow, we really just want to be able to bill the maximum amount for your services while checking off all the regulatory boxes saying that you’ve done what you’re supposed to do.”

        • DeceasedMD1

          Remember the days when doctors were actually respected and in charge? The problem you mention is the fundamental problem now in medicine. How is it we are not in charge of even our own records? Obviously they should be listening to you.
          These opportunists have the power now and are actively destroying the medical record. It is sabotaging medical care. It is a not a secret that no one likes EPIC except for the EHR company making bundles from it.

          • SteveCaley

            As a bit of a programmer, I actually have constructed “front-end” structures from the provider’s perspective. They were unapproved and discontinued as impermissible by the forms committee.

          • guest

            No surprise there…

        • Arby

          I worked with programmers and although they would often work insane hours (on salary) to invent and code solutions no one wanted to pay them to do either, especially if the ask didn’t come from or serve management.

          • SteveCaley

            The generation of “data” no longer has anything to do with its connection to “reality.” An analog concept, “reality” often comes up with answers that are embarrassing and difficult to handle.
            The general level of statistical sophistication in the techno-reform wizards is hardly that of a decent AP mathematics course. They imagine that all things are quantifiable, and all quantifiable things therefore have independent meaning. The field is chock-full of execrably bad assumptions, and thus produces huge reams of worthless data. Somehow, the Borgs seem to believe that excretion of data is a vital life function. Good onya, mate.

  • SteveCaley

    Given the premise that human beings are simply bundles of algorithms, there’s hardly even the need to see the patient! We shall care for, shepherd and eventually lay to rest the beloved Record that coexists with the meat puppet.

    • Arby

      The way it sounds I can easily see the record living on long after the patient or the patient living long after the record shows they have passed on. There is a Seinfeld episode here somewhere.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    “For now we will all continue dutifully clicking the buttons….”

    Why?

    • SteveCaley

      Because we live in times of astonishing idiocy. Well-paid lit. majors in cushy offices berate medicine for not being innovative enough.
      Is that why the surgical treatment of acute appendicitis hasn’t changed in fifty years? Oh, yeah, it has. Thromboocclusion of berry aneurysms in the Circle of Willis, not very different I suppose since the Civil War. In truth, medicine is a rapidly-advancing and lean profession, and has always been so. Innovation, technology and information theory HAS been there for decades, you doofuses. The very people who have been part of the problem, and ridden as moochers on the back of medicine like fleas, are now insisting that the Dog is merely a transportation mechanism for the Parasite. They assume that medicine is a click of a button. Go ahead then – click! And watch what happens with Google Glass! And blog it on Twitter! Dress the Emperor up in his new clothes, why don’t you?

  • buzzkillerjsmith

    Typing bad, reading something that has been typed, as long as it is not crap, good.

    Afferent, not efferent.

    Next case.