Robert Lending, MD, describes himself as a “computer dinosaur.” The Tucson, Ariz., internist and clinical lipidologist gets cash from bank tellers rather than ATMs. He doesn’t make online purchases or use social media. And he doesn’t use electronic health records.
Lending, 65, calls EHRs “the most dangerous, ridiculous piece of equipment I could ever have conceived of,” adding that his colleagues envy him for the peace of mind and extra time he enjoys from using paper charts.
“You can’t believe how angry they are at computers, at the whole system,” he says.
Lending is far from alone. True, physicians’ use of EHRs has soared in recent years, due in part to the financial incentives the government provided through its Meaningful Use program. According to the most recent data from the Office of the National Coordinator for Health Information Technology, 87 percent of office-based physicians were using some form of EHRs in 2015, up from 24 percent a decade earlier.
Still, that leaves a lot of doctors who aren’t using EHRs, despite pressures from the government, payers, and sometimes their own colleagues to do so. Medical Economics spoke with some of them to find out why.
Robert Lending, MD
Since beginning practice in the early 1980s Lending has watched as EHRs have spread throughout the healthcare system.
Now he is among a handful of providers at his large, multispecialty practice who continue to use paper charts. While conceding that EHRs offer some benefits, such as data mining and e-prescribing, for the most part he has not liked what the technology has done to physicians or the profession.
“Most of my colleagues are spending an extra one to two hours per day just doing their records, often at ridiculous times,” he says. “Like they’ll see a patient on Tuesday afternoon and finish the note [for that patient] on the weekend.”
Lending dictates his notes on an iPad during the patient visit, in part because he values the level of detail and accuracy it allows.
“When you’re doing a note four days later it’s hard to remember if it was the second left proximal knuckle or the third left distal knuckle,” he says. “My ability to create a useful, accurate note lessens even a day later.” He e-mails the dictated note in audio format to a medical transcription service.
Lending estimates that the government docks him the equivalent of 2 percent to 3 percent of his Medicare reimbursements for not using EHRs. “But I’m willing to give that money up so I’ll have all my charts done before I leave the office, every script is taken care of, and my desk is clean,” he says.
Similarly, he misses out on a portion of bonuses the practice receives tied to quality data gleaned from providers’ EHRs. “But that’s another thing I’m willing to give away so that I can just do my thing and be a doctor,” he says.
Lending says that if he were younger and had more years of practice ahead he would probably have gone digital by now because “Who knows, ten years from now it may be illegal even to use paper.” As it is, EHR use now is a requirement for any new provider joining the practice. But he is determined to hold out.