Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The EHR report card 2014: Has it gotten better?

Yul Ejnes, MD
Tech
October 16, 2014
352 Shares
Share
Tweet
Share

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

A little over two years ago in this blog, my “EHR report card” evaluated the effect of the electronic health record (EHR) on my practice. I thought it would be interesting to see how things have changed.  As in 2012, I will not identify my EHR, since I suspect that much of the report card will be applicable to many products.

If you are looking for vendor-specific information, a great source is AmericanEHR Partners, which the American College of Physicians (ACP) co-founded. There, you can read user-submitted ratings and reviews for many EHRs and submit your own evaluations.

Time. Two years ago, I observed that my typical patient care day was about half an hour longer than it was pre-EHR. Now, my average patient care day is a little shorter compared to pre-EHR. I attribute this to my adopting voice recognition to enter the history of present illness, assessment, and plan. Doing so eliminated many clicks and other mouse-intensive tasks. Using voice recognition also has the benefit of producing a note that is written mostly in English, as opposed to what most EHRs produce.

I am also better caught up with reviewing labs and communicating results to patients. I believe that is partly from new features added in upgrades over the years and from my learning new ways to use the software. In addition, a growing number of patients are getting their results via the patient portal, which saves me time. Easy access to records from anywhere any time continues to increase my efficiency.

Because of these developments, my workweek is a couple of hours shorter than it was two years ago. I’m actually able to take a few hours of my “day off” off. In 2012, I gave this area a grade of “meets expectations,” but in retrospect, I was being very generous. In order to be consistent and show improvement, this time the grade is “slightly above expectations.”

Practice finances. Last time, I gave this area a grade of “above expectations.” This was based on several easily measurable changes, such as reduced staffing needs and revenue from payer incentive programs, including meaningful ese. The EHR’s impact on finances is not as easy to isolate today, but without it, we would not have succeeded in our medical home and ACO, both of which require population management. Maintaining the EHR is expensive — my practice employs several staff members dedicated to keeping the EHR and network running — but even with this additional overhead, we’re coming out ahead in ways that would not have been possible without an electronic record. I grade this “above expectations” again.

Quality of care. In 2012, I pointed out the advantages of the EHR in measuring the quality of care across my patient panel, helping to identify gaps in care, and making on-call care better. I’m still frustrated by the amount of work that it takes to generate reports and how much of that has to be done by IT staff. New tools that let the individual physician crunch the data just became available, so we’ll see if that improves the grade.

My greatest disappointment in the last report card was in the area of decision support. I can’t say that things are much better today. I’m still running ACP’s SmartMedicine on an external web browser and wish it or something like it were integrated with the EHR.  I grade this category “below expectations,” which is unchanged from 2012.

Information exchange. This got a grade of “below expectations” in 2012, and I hoped at the time that meaningful use and other developments would improve interoperability. I’m still hoping. Regional health information exchange (HIE) has advanced greatly in Rhode Island, but I cannot move HIE data to and from my EHR. Beyond that, I still cannot share electronic data with other physicians seamlessly, even with users of the same product.  This marking period, because of the unmet expectations at this late date, I give this area a lower grade of “unsatisfactory.”

Reliability and safety. Not much has changed in this department. We have occasional “hiccups,” but other than the couple of days our EHR was off line during an upgrade, we’ve had little downtime. I continue to appreciate that the greater availability of patient data facilitates my making better-informed (and safer) decisions. On the negative side, there are days that response speed could be better. As I wrote in 2012, one has to be vigilant about EHR-introduced errors, which, fortunately, are rare. Again, the grade is “meets expectations.”

As in 2012, the report card is mixed, but I think this is more consistent with reality than the “all bad” or “all good” commentaries on EHRs that we often see. Even with the changes since the last report card, the overall grade is the same compared to two years ago. I am especially discouraged by the lack of progress regarding interoperability, a topic that ACP wrote about as early as 2004 and is attracting greater attention these days. While the software is not evolving as quickly as I would like, the ways that I interact with it are changing more rapidly. I’m always finding new (usually better and faster) ways of doing things.

Of course, this is one person’s perspective. I would be interested in reading about yours.

Yul Ejnes is an internal medicine physician and a past chair, board of regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Prev

Why the Apple Watch won't disrupt health care. Yet.

October 15, 2014 Kevin 1
…
Next

To be or not to be: An artist in medicine

October 16, 2014 Kevin 15
…

Tagged as: Health IT, Primary Care

Post navigation

< Previous Post
Why the Apple Watch won't disrupt health care. Yet.
Next Post >
To be or not to be: An artist in medicine

More by Yul Ejnes, MD

  • Different perspectives but the same goal: providing the best possible care to patients

    Yul Ejnes, MD
  • Rising premiums, high deductibles, and gaps in coverage before the ACA

    Yul Ejnes, MD
  • Improving physician satisfaction by eliminating unnecessary practice burdens

    Yul Ejnes, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Improve mental health by improving how we finance health care

    Steven Siegel, MD, PhD
  • Proactive care is the linchpin for saving America’s health care system

    Ronald A. Paulus, MD, MBA

More in Tech

  • What I think it means to be a medical student in the wake of AI

    Jackson J. McCue
  • The rise of generative AI in health care: Here’s what you need to know

    Anil Saldanha
  • Can AI solve the physician shortage crisis?

    Harry Severance, MD
  • Bridging the digital divide: How to bring trust back into the patient-physician relationship

    Arti Masturzo, MD
  • Can foundation AI models like ChatGPT and Google’s Bard be used for automating medical scribing?

    Dr. Sushindri Sridharan
  • ChatGPT: How generative AI is revolutionizing health care

    Robert Pearl, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 13 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The EHR report card 2014: Has it gotten better?
13 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...