In 2009 the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law by President Obama and this law quickly changed the way medicine in the United Sates is practiced. The law was a first step in requiring all physicians to utilize electronic records. The president promised that creating and electronic record mandate for physicians would result in a national, universal electronic medical record system and improve care and communication. Ultimately, the legislation that required EMR implementation in 2009 began the process of penalizing physicians who do not use them and started a lucrative business for healthcare IT vendors such as Allscripts, EPIC, Cerner and many others. The requirements to implement EMR resulted in thousands of physician practices having to make harsh financially motivated decisions — either close the doors or sell out to larger healthcare systems.
What are the benefits of EMR? What are the practical drawbacks?
Certainly, EMR systems do have their benefits — standardized documentation and portability all improve care. When a patient travels and has an illness care is improved when another hospital and provider can easily access long-term medical records. Communication between physicians of different specialties and organizations is significantly improved.
However, EMR vendors have not yet created exchangeable, universal systems as Mr. Obama promised they would. Each vendor creates their own platform and continues to compete with other EMR makers by creating different interfaces: Each EMR platform has its own idiosyncrasies, and none is perfect. The Obama administration failed to put any mandates on EMR vendors; they were allowed to produce whatever they liked.
The burden of integration has been dumped squarely in the laps of health care providers. In addition, EMR systems have been designed as billing tools and not for clinical documentation. Hospital systems are able to reduce billing and coding staff and now force physicians and other healthcare workers to perform this role as well. Because of the design focus of EMRs to capture maximal billing they are often clinically irrelevant and woefully inefficient in the clinical setting.
There is a significant learning curve for physicians and other health care workers when changing from one system to another. These transitions often bring operations to a crawl as productivity and efficiency decline for several weeks to months — ultimately negatively impacting patients.
How has the EMR requirement affected physicians and patients in the last decade?
A study published in the Annals of Internal Medicine found that physicians are spending twice as much time logging data into electronic medical patients as they are actually spending time interacting with patients. In the study, investigators observed nearly 480 hours of clinical time from the practice of 57 physicians across multiple specialties — including family medicine, internal medicine, cardiology, and orthopedics.
Investigators found that during a day in the office, physicians spent 27 percent of their time seeing patients and 49.2 percent of their time on the EMR or doing deskwork. In addition, these physicians also did 1 to 2 hours of EMR time at home during family time every single night. Ultimately the study found that for every hour physicians spend providing direct face to face patient care, they then spend two hours working on the EMR.
Obviously, this type of scenario is unlikely to be sustainable. Physician burnout and dissatisfaction with their job is at an all-time high; more younger doctors are retiring early and looking for employment in other industries. More importantly, many patients are beginning to feel isolated and unable to develop any type of meaningful relationship with their physician.
We must get back to a patient-centered focus for the U.S. health care system. We cannot allow a computer screen and government mandates to separate doctor from patient. We must demand that physicians be given the time and space to interact with patients in a meaningful way that allows for a human connection. While documentation and EMR technology is an important part of clinical medicine, we must not allow the computer to be the focus of the clinical visit.
Here’s what I think needs to be done:
- Keep laptops out of a physician’s hands in the exam room.
- Require universal connectivity and easy interaction between different EMR platforms/vendors.
- Reward physicians for quality care, not for quality EMR notes.
- Make EMR interfaces more clinically relevant, easier to use, and more efficient (i.e., not as billing tools).
These are not easy goals to achieve. However, we must work diligently to make changes or patients will become more isolated, and medicine will no longer be a human interaction between doctor and patient. These changes will only be possible if all of us work together — patients and doctors — to demand legislative reform.
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