Why EHRs are flawed, and how they can be fixed

Electronic health records continue to get a bad rap—at times, justifiably so. The recent article Death by 1,000 clicks: Where electronic health systems went wrong has spurred new conversations about what can be done to fix EHRs, including making them more physician-friendly and efficient at driving safe, effective patient care.

One school of thought is to replace existing health IT systems with newer technology. For example, a recent Reaction Data report revealed that almost 40 percent of surveyed outpatient providers are looking to replace their EHR and other IT tools with solutions that offer better ease of use, more functionality and increased interoperability with other IT systems. An additional one-third of the surveyed providers indicated dissatisfaction with their current solution, but didn’t have plans to switch systems because of the expense and disruption to their practice.

Regardless of whether organizations choose to keep or replace their current IT solutions, it’s clear that physician dissatisfaction is high—and that, as an industry, it’s time to advance the dialogue and take action to fix our flawed EHRs where they hurt most.

Before we fix EHRs, we first must ask clinician users what they need and what isn’t working. Rather than dictate prescribed workflows, it’s important to ask clinicians to identify the changes that would make their existing systems more efficient and give them the critical decision-making information they need, when they need it.

Bloomberg file photo

By incorporating clinicians’ recommendations for system design and workflows, we can optimize EHRs to improve patient care and physician productivity—which would also enhance clinician satisfaction.

Today, EHRs store massive amounts of clinical information, yet much of it cannot be easily accessed by clinicians at the point of care. Despite the digital revolution, we have largely failed to equip clinicians with systems that support clinical workflows and align with physician thought processes.

Instead, we have given clinicians huge blobs of data that are not logically integrated, requiring users to sift through records to find the details relevant to an individual patient and the patient’s specific problem.

EHRs should accommodate—not hinder—clinician workflows. The most powerful computer in any treatment room is the clinician’s brain—and it’s essential that we give clinicians the time and mental space they need to actually think about the patient in front of them, rather than forcing them to sift through huge volumes of electronic data.

We must fix EHRs so that clinicians can find all the relevant clinical information on individual patients, at the point-of-care, within a click or two. With ready access to a patient’s complete record, clinicians are empowered to confidently deliver safe and effective patient care. With more efficient tools, we can help drive greater clinician productivity and eliminate many of the inefficiencies that are fueling clinician burnout.

Workflows should not be dictated by the EHR, but by the individual needs of each clinician. A specialist, for example, has different needs than a primary care physician, and the EHR must support workflow customization. Users need flexibility in how information is presented and the ability to filter information to match an individual clinician’s thought processes and provide easy access to the right data for the right patient at the right time.

Safe and effective patient care must be the top priority for all stakeholders. Providers and vendors must put aside their fears of losing market share and make it easier to share complete patient records with other providers.

To promote data-sharing, we need to enact and enforce penalties for data blocking. Unless clinicians have easy access to a patient’s comprehensive health record, we will struggle to bend the cost curve, make healthcare safer and improve patient outcomes.

As the Reaction Data survey discussed earlier revealed, not all providers are willing and able to invest the time and money for a new IT platform. Fortunately, providers wanting to enhance the usability of their systems have the option to incorporate a wide variety of app-based solutions into their legacy EHRs.

Using established standards such as FHIR, many of these technologies are designed to fix inefficient workflows that diminish physician productivity. For example, some apps may focus on organizing existing data so that clinicians can easily access the data they need on demand—even if that data is coming from an outside system. Other app-based solutions enable more complete and accurate documentation to facilitate quality care, correct reporting and better clinical and financial outcomes.

Yes, EHRs are flawed—but also fixable. It’s time for healthcare to fix the flaws and embrace improvements that advance the delivery of quality patient care.

David Lareau
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