Tech-savvy docs need to be on the forefront of EHR reform

I remember the disdain some of the EHR trainers had for their trainees back when our hospital system “went live” several years ago. Of course, this disdain was tempered by their knowledge that if docs weren’t so computer illiterate, or the user interfaces of the EHR systems weren’t so awful, or if the EHR software wasn’t so bug-ridden, their jobs wouldn’t exist.

So they soldiered bravely on, undaunted by grumpy old docs who now had to type their notes despite never learning how to touch type, who had to reconcile medication lists a mile long including meds like cinnanom that they really could care less that the patient was taking but had to be reconciled nevertheless, who had to painstakingly enter orders using an interface designed by an engineer who knew as much about medicine as — an engineer, and who were angry and resentful that this newfangled computer system was being shoved down their throats under threat of loss of government Medicare reimbursement. Given the tensions and personalities involved, it still amazes me that the EHR transition was accomplished without loss of life or limb.

Maybe the classes helped. Long before the go-live date, we went to EHR school. This consisted of several days of classes, during which the world of health care delivery was supposed to stop (it didn’t) while all medical personnel sat around drinking coffee and listening to talks about how the EHR was supposed to work. Even though this was a useful education into what the life of a hospital adminstrator must be like, the real world of patients and disease tended to encroach on the world of mouse clicks and meaningful use butttons to the point that I skipped the last afternoon of classes and the final exam.

Unfortunately my truancy was detected and, under penalty of garnishment of wages, I was forced to do a make-up class. Despite the rigorous training, the number of months that elapsed between EHR school and going live ensured that I and my colleagues had pretty much forgotten everything we had learned — hence the need for the EHR trainers.

I was a little disappointed that I wasn’t selected to be a “superuser.” A superuser is a user who is technically savvy and enthusastic about using the EHR; a true believer who could help other users who were having problems, even after the EHR trainer cadre had long since departed to initiate other hospital systems in the EHR religion. I suppose I failed to qualify on my lack of zealotry. I also kept my technical savvy under the radar. So I became merely a user. I found that, unlike my experience with other forms of technology, the EHR was making my life worse. Simple tasks became complex. My work slowed down. More mistakes were made. I was stunned. I could not think of any other example where a computer program was less efficient than the technology it was designed to replace. But it appeared that EHR systems were a counterexample to this.

So I decided to write a few blogs about how bad our EHR was, but the EHR company, who employs people whose sole purpose is to scour the Internet looking for screenshots or bad-mouthing of their precious software, caught wind of this and reported it to the administrators of the health care chain I worked for. After some angst, I agreed to shut up for a while, though now that I am retired, I don’t feel bound by any non-disclosure agreements the hospital system signed with the EHR company.

EHR advocates have sometimes commented that once all the old, non-technological, non-touch typing doctors die off, then everyone will be pleased as punch with their EHRs. The new generation of doctors, raised on technology, able from infancy to handle a PlayStation controller with aplomb, will have no problem using EHRs. There is some truth to this, but this criticism misses the point of my and others’ criticisms of current EHR software.

There are plenty of technologically sophisticated doctors of all ages who are uncomfortable with the state of EHR systems today. I have written computer software and most would consider me one of these “geeky docs.” Most of the critiques of EHRs that I have read have been from technically sophisticated physicians, not from the technological dinosaurs that the EHR pushers believe make up the majority of doctors today. None of us wants to go back to a pen and paper chart system. All of us want to see EHR systems improve in usability and interconnectivity. We all use computer software in our daily lives and know that EHR programs don’t measure up to standards that other computer programs meet. We don’t like the secrecy of the EHR companies or the astronomical cost of the software. But mostly we just want the software to get better. This won’t happen unless the software designers start listening to users. Tech-savvy docs need to be on the forefront of this. We need to push for change and not allow the EHR companies to keep falling back on their old excuse: If you docs only knew how to type, you’d love our system.

David Mann is a retired cardiac electrophysiologist and blogs at EP Studios.

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