“That kind of information is useless to me,” she says. “I want to know if the patient is feeling better or worse. That’s not structured data, but it tells me a lot. For instance, if he’s having chest pain I need to know what the pain is like, how he described it. When people have chest pain, you have to write what they actually said, so you can know the next time whether it’s the same thing or something different. You don’t get that through a checklist.”
Poplin attributes the reliance on checklists, as well as many other features of current EHRs, to the fact that the systems are designed primarily as management and performance measurement tools. Referring to her residency experience, she says “My point is, an EHR that’s primarily for taking care of patients will look quite different from one that’s designed to manage.”
But Christopher Apostol, DO, a primary care physician in an Evans, Georgia-based group practice, thinks some doctors bring their frustrations with EHRs on themselves, either by expecting too much of the technology or not taking the time to learn it thoroughly.
“A lot of times doctors want to customize their EHR instead of using the tool as it was designed,” he says. “I think you need to view the EHR more like an autoscope. I can’t make the autoscope do things it wasn’t designed to do. I have to use it for what it is. And that’s what you have to do with the EHR.”
Apostol, who was not part of the survey and whose practice uses athenahealth EHRs, says he’s satisfied with most aspects of the product, in part because he understands what it can and can’t do. “But what I hear from physicians not liking theirs is usually because they haven’t spent enough time learning how to use it properly,” he says. “Of course there can always be improvements, but I think in general doctors need to spend more time understanding what they bought and what they’re using so they can use it to its fullest.”
Mackie (athenahealth): It’s incredibly depressing that healthcare is the only industry that has managed to lose productivity by going digital. Many EHRs are still little more than glorified databases, hijacking physicians’ time with clerical work while patients receive less attention. Part of the failure lies in the original concept: EHRs were made for documenting information to support billing and defend against malpractice, not for improving care delivery.
athenahealth’s EHR is better than most, but to be honest, we’re a leader in a really bad lineup and there’s a lot of room for improvement. There are several things that we’re prioritizing and investing in to remedy this.
We’re investing heavily in mobile, which allows our customers to use touch and voice technologies more fluidly and gives them more freedom to connect during those “in between” times outside of a clinic or hospital.
Comments from physicians like Dr. Poplin have motivated us to provide a more natural documentation process and bring back the patient’s health story. The EHR needs to do more work “behind the scenes”—structuring narrative and voice input and synthesizing disparate data from throughout the healthcare network into easily digestible summaries of what’s happening with a patient.