Meaningful Use Criteria Challenges
I think [the EHR] was created to get us a gold star for “meaningful use” but not to make it easy for a physician [with] on boots on the ground to use it. … They really aren’t really hitting their user group very well. I think, for me, one of the big frustrations is there are so many things that I need to put in there now. … I have to make sure all the i’s are dotted and the t’s are crossed, because we want to make sure we’re hitting on all of our measures.… And so it requires that probably half the time that I’m charting, I’m dotting those i’s and crossing those t’s and making sure that I work the chart, which is not taking care of patients. … I’d rather spend that time face to face. … So I think what we’ve created is almost a monster, when really what we were shooting for was good patient care. And that’s unfortunate.
—primary care physician
Financial Impact
The downside is cost. I mean, the cost is tremendous. And you know there are competing companies out there, but that doesn’t necessarily mean that they have a better product. And if you switch to a competing company, you just have to start from scratch. And the cost for what they offer is just astronomical. And there’s no way to put a price tag on it. I mean, you can compare cars and figure out what price you want to pay for this car versus that car, even if they’re different models, but you can’t do that with EHRs. … And we have been involved with [EHR vendor] since the beginning of our EHR, and [EHR vendor] has been going through some changes at a corporate level as well. So you’re always worried, what’s going to happen with [EHR vendor]? Are they going to get bought out by somebody else? Are they going to cease to exist? Or are they going to continue to service their product? It’s very worrisome.
—primary care physician
Ongoing EHR Maintenance Costs
[The EHR] is not just a one-time investment. It is a hugely expensive, ongoing, every freaking day investment. So over the years, I have … spent probably three quarters of a million dollars since [adopting our] electronic medical record, because every year, you pay 20 percent of the value of it. And there’s sometimes between 8 and 15,000 dollars a year in support fees. There’s new computers. I think we have 16 computers, and every year we probably have to replace at least three to five of them. The printers. The IT support to come get everything connected. When we moved [to our new office], we bought a new server. A year later, with “meaningful use,” my vendor said “Guess what? Your server doesn’t work with that. Now you have to buy another 12,000 dollar server.” … Because we’re small, we don’t really have an IT person. [The IT person], scarily, is me, and I’m like the least qualified person in the room to be the IT person. And then if you want to get somebody who is that qualified IT person, you’re looking at several thousand dollars a month. Well, a practice this size can’t really justify somebody that’s 2,000 dollars a month for IT support.
—primary care physician
EHRs Require Physicians to Perform Lower-Skilled Work
I’m not a clerk. At least, I don’t think I am. I’m more efficient calling [a clerk] into the room and saying, “Okay, set up Mrs. Jones for tests A, B, C, D and F,” and you go do it. I don’t know how long it takes you, but what I do know is that I’m done, I’m moving on, as opposed to when [I enter the order myself]: A click, B click, C click, D click. Oh, I need to give a reason for D, open up the box, click, click, click, click, okay, close the box, and verify, and quantify, oh, and commit, so that we get “meaningful use” out of my interaction. That takes time. Am I more efficient than the world at large? Yes. But am I a clerk? No. So, everything is just a couple of clicks, but if you followed me around and looked at how many “couple of clicks” tasks I do, it takes time. And I could do all that, but then there’s a personal value decision. I prefer to look at you [the patient] when I’m talking to you, [rather] than look at the computer screen and glance at you sideways. So, I’m either a dinosaur, or a slow adopter, or there’s something wrong with our EHR efficiency concept.
—cardiologist
What’s really happened is since going on [the EHR] is that I’ve really taken on the responsibility of transcription as well as billing, in addition to the other things. … It’s given me more mundane clerk-like duties to do. The derogatory term, I guess, in residency, was “scutwork.” And that’s what [the EHR] has done.
—primary care physician
Clinical Documentation
We’ve been in the [EHR] system for what must be almost three years now. It’s hard to believe it’s been that long. And how do we like it? … As with all electronic medical records, I greatly dislike the document that’s produced. We live in a world now where almost every provider, or at least I would say the majority of the providers around here, seem to have electronic systems, none of which are particularly easy to interpret. And it is a source of general, I think, dissatisfaction among the physicians that we have been forced to abandon [a way of documentation] that was always very effective and very succinct. And the days of being able to dictate in a meaningful fashion, in the form of a letter or a concise document to send to a primary care doctor, are gone, and that’s lamentable, because that has been a step down in quality. These new documents are unreadable because you’ve got to skim through them really quickly and say, “Where’s the meat here?”
—cardiologist
I don’t think anybody’s found that “better [documentation]” means quicker unless [doctors are] just using some completely macro note [in which] you just pull things in and don’t have any additional input. … I mean, just a lot of the crap [is] in there when I get [notes from] consultants. Ninety-five percent of what I get back is just BS, pulled in from a chart somewhere with no thought involved.
—primary care physician
So here’s what’s happened with the EHR. I mean I get it, I understand it, but it has been a step backwards, I think—and as big a step backwards as it is forwards. The step backwards is the problem of templated information. … There’s templated information in the review of systems. [I think:] “Really? You asked all those questions?” Not really. “Well, what percent? 80?… 70?… 60?… 30?… Did you ask any questions, really?”
—general surgeon
Future of EHRs
All of a sudden, you’ve got this incredible goliath of information that is interfering with the ability to communicate between providers what they need to be able to communicate. So it’s in transition, and I know that 10 years from now or 15 or 20 years from now, I can imagine that the next level of EHR is going to be software, smart software that can scan an eight-page document and then give me a third of a page summary of important information, because there was some software engineer who’s medically trained. That, to me, makes the next logical step. Then also complete interconnectivity and transfer of information across all systems, … so that we’re not constantly reloading and scanning. [But currently] we’re in a very difficult, rudimentary phase of conversion to the EHR that quite honestly has, I think, been a bigger headache than advantage for physicians, and the only reason they did it was because there was some dollars assigned to it.
—general surgeon
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