Attempting to solve EHR errors is an impossibly doomed mission

July 10, 2016

EHR errors and MOC frustrations are the hot topics of this issue's Your Voice.

Regarding the May 10, 2016 article “Preventing malpractice lawsuits due to EHR errors,” I am forced to point out a number of errors in logic and some naiveté on the part of the articles author.

 

Related: Why is EHR use dropping? 

 

In the section titled “Documentation Challenges,” Aine Cryts quotes  Jeffrey Kagan, MD, who says that “while using templates can be helpful you have to make sure they they’re individual to that patient and that particular visit.” He then urges physicians to “slow down a bit” while failing to acknowledge that the very thing which prevents physician’s from slowing down are the burdensome inefficiencies of the very EHRs we are discussing. 

It would be far more helpful to work towards more physician-oriented EHRs than it is to patronize physicians by telling them to see fewer patients in an environment where dropping reimbursements require just the opposite.

Another complaint with the commentary in this article is the statement concerning alerts. The author acknowledges that physicians are ignoring alerts because of the barrage of meaningless alerts, but then moves on to imply that this is no excuse and the solution is to work with the EHR vendor or the IT department. 

 

Related: It's time to get doctors out of EHR data entry

 

In the past 5 plus years, I have worked with two EHRs, Allscripts for the first five years and Epic for the last seven months. Each system has its strengths and flaws but both are hampered by the same glaring weakness. That is their complete failure to give physicians direct input into the design of the system beyond minor modifications already built into the software. 

My own requests to adjust the alert messages have fallen on deaf ears with both systems. It’s the medical equivalent of tilting at windmills. Physicians are human and cannot help but be so. We cannot remain eternally vigilant when thousands of false alarms are presented to us every day. Picking needles from a haystack is difficult when its your only task, but trying to do so while performing a dozen other tasks is an impossible mission doomed to failure.

When the military pilots were faced with a similar information overload in the cockpit of modern fighters, military planners provided their pilots with much more than useless words of encouragement. They fixed the systems so that only the most important data for the situation was provided to the pilots. 

The healthcare community, society, EHR vendors, and lawyers need to stop blaming physicians and offering ineffectual solutions. Failures in the use of current EHRs are not physician failures. They are failures of the systems that should, but don’t support them. 

We make life and death decisions at least as impactful as a fighter pilot. We deserve the same respect or more and equipment that is at least as good. To all of those groups cited above, I have only these words: you can offer advice on how to do my job better when you have done yours well.

 

Michael Melgar, MD

Great Neck, New York

Next: MOC makes me happy I don't have 30 more years to practice medicine

 

MOC makes me happy I don’t have 30 more years to practice medicine

 I am a family physician and was board certified in family medicine for 27 years.  When the board of family medicine decided on not only an every 10-year exam, but a yearly exam and a 10-year exam, I elected not to participate in 2007.  

The fees produce income that seems out of proportion to the production of a yearly exam taken on the internet. 

 

Further reading: MOC is crazy and unfair

 

Who are these board members and how are they chosen?  If they are paid, what are those salaries?  Are they reimbursed for travel to their meetings?  What is their budget and how is that money spent?  It is curious that both the national and state organizations who fall right in line, are more interested in monitoring and inhibiting doctors with the most training and experience, while at the same time giving more and more freedom to those with less training, specifically nurse practitioners and physicians assistants. 

I’m sure the subspecialists see this as an encroachment into family medicine, but can’t see an extension to their specialties.  I have seen “psychiatric nurse practitioners.”  Is encroachment into the operating room very far behind? 

We are told there is a shortage of general surgeons.  Will insurance companies and their “certification process” become a method by which family doctors can supplant “extenders”?  Reimbursement rates certainly favor that approach for the insurance company. 

I am pleased that Dr. Savoretti is in a position to “tell them where to go”, but many of us do not wish to be shoved out of a career we have loved for more than three decades by a bunch of bureaucrats who have no feeling for either the practice of medicine or the patients we serve.  It is ironic that these changes in the practice of medicine are most likely to affect our age group.

I work in a small community where board certification has not affected my ability to practice, but hospitalists and manipulation by big companies who provide hospital administration, have effectively shunted us out of the hospital. 

In my state, a state legislator has suggested that the medical board begin “”monitoring older doctors.”  The specifics of how they intend to do that are as nebulous as the new buzz-phrase “value based medicine.”  

Bureaucrats are predicting “we will no longer pay doctors to see sick patients, but rather pay them to keep us healthy.” Somehow they think health and prevention begins in the doctor’s office, rather than at home.  I am certain that every generation of physicians has observed the changing landscape of medicine with some skepticism, but the panoply of changes, currently driven by both state and Federal bureaucrats, is truly disheartening. 

I have never thought I would be happy to say that I don’t have another 30 years to practice medicine.  Young physicians coming out of training will review their options and find a niche that I hope will be as satisfying for them as medicine has been for my generation.  However, I remain skeptical.

 

Frank DiMotta, MD

Ruidoso, New Mexico