User friendly recording of data often seems like an EHR afterthought


As I began logging on to my third different hospital EHR (electronic health record) recently, I contemplated how much more of this I could take. Being less than a year from planned retirement, the nuances of learning a new EHR and CPOE (computerized physician order entry) system is not fun. Furthermore, every hour I spend learning a new and unique system is another hour less devoted to patient care, and more to machines, not to mention the sapping of mental energy. I will grant that some of this is generational. My younger partners seem to pick this stuff up quicker than I do. Yet, even they express frustration with the inconsistencies and variability of dealing with different programs.

First you should know I do not have technology phobia. Actually I embrace it. Our cardiology practice has had an EHR since 2004. Furthermore I own an iPhone, iPad, and am active in social media, so I have chosen to be computer savvy. Yet, there are certain things about hospital EHR systems that I find predictably annoying. To understand the clinician’s distaste for these systems, it is vital to realize that most were initially built for electronic billing. So for coding purposes, they work just fine. But user friendly clinical recording of data often seems like an afterthought.

Our group admits to, and consults at, seven hospitals, (four chains). So far, we have had to adapt to at least three unique computer systems. One of the hospitals belongs to the IASIS chain, and their system only has CPOE at this point. Thus no electronic progress notes. To make matters worse, an incomprehensible administrative decision was made to leave physical physician order sheets in the charts, so given that alternative, very few doctors use the CPOE. Why adopt it at all then?

I believe the answer is money. The federal government is paying out huge incentives to hospitals for adopting CPOE and EHR. How much? Well, a local rumor is that HCA (Hospital Corporation of America), which owns 162 hospitals nationally, has made over $1 billion dollars for adopting the electronic approach. It seems to me that the mere act of EHR/CPOE adoption is enough to garner federal funds without any critical examination of how it is used or implemented.

Two of our hospitals belong to Baycare Health System, which owns 10 hospitals on the west coast of Florida and employs over 19,000 people. They utilize a health record called BEACON. It is a complete EHR with electronic notes and orders. I found the system a bit cumbersome and the learning curve steep. However, once mastered it does seem to be easy to navigate and customize. Furthermore, the hospitals decided to utilize a voice recognition system for dictating, for those wishing not to relearn typing.

HCA chose to meld their EHR and CPOE onto their Meditech system. This was a bit curious for me since Meditech is ancient, (at least in technology years), having been founded in 1969. There is a new Meditech system but its operating system pre-dates Windows, (as in DOS or UNIX), so go figure. I have just started to use the system so the jury is still out for me. However, my initial impression is that it is easier to use than BEACON. But true CPOE doesn’t start for another month. One of the local HCA hospitals elected not to install voice recognition software. This is a mistake.

I have made several observations from this electronic journey.

First and foremost, no other industry takes its most highly skilled and paid employees (as in physicians) and force them to do the lowest paying job (as in secretary and order entry). This is just not a good use of our time and training. In some studies, productivity has suffered. Imagine the president of your local bank working the teller window and asking if you wanted your change in tens or twenties.

I am tired of finding a computer that works and a seat that is comfortable. I don’t want to use a computer where my knees are slammed up against a printer. Someone needs to regularly clean the keyboards (I would be happy to if sanitizing cloths were placed next to every machine). Studies have shown that keyboards are one of the most germ-infested locations in hospitals, even more than a toilet seat. Consider the paradox that we wipe down gym exercise equipment before and after use, but not the keyboards at nursing stations? No CEO, CFO, COO, or director of nursing would tolerate such uncomfortable and unclean conditions in their offices.

The new frontier of hospital EHR is evolving. It is not going away. What many doctors and I would like to see is more user friendly software, and clean and comfortable work environments.

David Mokotoff is a cardiologist who blogs at Cardio Author Doc.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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