EMR: It’s a Love-Hate Relationship
By: Kaitlyn Bali and Sophia Dinh
Electronic Medical Records (EMR) have made its way into doctors’ offices across the country. Used in place of physical paper copies of charts and records, the EMR contains information about patients, such as medical history and treatment information. [7]
In 2009, President Barack Obama signed the American Recovery and Reinvestment Act, which played a large role in encouraging the digitalization of patient records in an attempt to increase the efficiency of the nation’s health care delivery system. [5] Despite this, by 2012, there still was an estimated 63% of physicians that continued to utilize the fax machine as their primary form of communication, 12% of physicians could use EMR in a meaningful way, and only 6% could use their EMR and share it to another clinician with a different EMR system. [5] By 2019, 89.9% of office-based physicians were using any EMR/EHR system, and of that group, 72.3% were using a certified EMR/EHR system. [1] With the increase in EMR use, information exchange between physicians and pharmacies increased as well, from 47.2% to 55.0% over four years. [4]
While the integration of digitized medical records may seem like a positive outcome, more than 50% of EHR/EMR systems fail or are not utilized correctly. [3] According to the 2019 National Electronic Health Records Survey, 34.1% of physicians answered that it was “somewhat difficult” or “very difficult” to document clinical care using their EMR. In the same survey, 75.6% of physicians answered that electronic exchange with providers using a different EHR vendor is challenging. Along with challenges in exchanging information with other providers, 56.8% of physicians reported that they disagreed with the statement that “the amount of time I spend documenting clinical care is appropriate,” and 57% of physicians disagreed with the statement “the amount of time I spend documenting clinical care does not reduce the time I spend with patients”. [4]
Why aren’t doctors loving such an innovative piece of billion-dollar technology?
Dr. Atul Gawande, staff writer for The New Yorker, endocrine surgeon, and professor at Harvard Medical school, delves into his and his colleagues’ experience with the EMR in his well-known “Why Doctors Hate Their Computers”. Gawande starts off his narrative by describing the details of his morning with other surgeons at a training session for the Epic system, a new medical software the physicians were expected to learn how to use. [2] “The surgeons at the training session ranged in age from thirty to seventy,” estimated Gawande, “about sixty percent male, and one hundred percent irritated at having to be there instead of seeing patients.” [2] With his witty sense of humor, Gawande emphasizes the value of patient interaction for doctors. The EMR stands as a burden to physicians who believe that the most important role of a physician’s work involves availability and attentiveness to a patient’s needs. With the implementation of this new piece of technology, physicians spend more than half of the time they have with their patients working with the software to record and access information. [2] With this came the rise in longer work hours for physicians, accompanied by increases in depression and suicidal contemplation rates for these healthcare workers as well. [2] Gawande concludes his report on these trends with concern for his community of medical providers:
“Something’s gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.” [2]
Dr. Susan Sadoughi, an internist working at the same hospital as Gawande, provided her frustrations with the EMR. Once excited about the possibility of streamlining care, Sadoughi has now grown frustrated with the extra hours she spends at home completing work tasks on her computer [2]. She has also grown frustrated with the disorganized nature of the medical issues listed for her patients (as a result of input access being provided to more people than before), the longer pieces of information to sort through, and many other redundancies. [2]
Patients also report feeling alienated during some doctors’ visits as well. Patients report feeling uncomfortable discussing personal issues only to have the physicians turn to their screen to type down information. [6] Patient and physician interactions have grown more awkward and less natural with the increasing use of the EMR. [6]
So what are some of the suggested steps for physicians trying to preserve their relationships with patients while also attempting to reap some of the benefits of a paperless EMR system?
Physicians can try to involve other colleagues in observing their interactions with patients and providing feedback. [6] Involving others in attempts for improvement allows for the identification of overlooked solutions and weaknesses. [6] Explaining to patients what is being looked at and typed into the computer also helps to involve patients in the process as well. [6]
The EMR is extremely beneficial in the field of medicine. Efficiency in retrieving notes, data, and results has greatly increased with the use of electronic methods. With time, the EMR will evolve to better fit the needs of doctors and patients. As for now, we must adapt to this change in the field of medicine and continue to provide feedback for developers who will only continue to enhance technology to promote the ideals of patient-centered care.
References:
[1] Centers for Disease Control and Prevention. (2021, October 14). FastStats — electronic medical records. Centers for Disease Control and Prevention. Retrieved February 8, 2022, from https://www.cdc.gov/nchs/fastats/electronic-medical-records.htm
[2] Gawande, A., Mukherjee, S., & Groopman, J. (2018, November 5). Why doctors hate their computers. The New Yorker. Retrieved February 8, 2022, from https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers
[3] Gesulga, J. M., Berjame, A., Moquiala, K. S., & Galido, A. (2017). Barriers to electronic health record system implementation and Information Systems Resources: A structured review. Procedia Computer Science, 124, 544–551. https://doi.org/10.1016/j.procs.2017.12.188
[4] NEHRS 2019 public use file weighted estimates — cdc.gov. (2019). Retrieved February 8, 2022, from https://www.cdc.gov/nchs/data/nehrs/2019NEHRS-PUF-weighted-estimates-508.pdf
[5] Reisman, M. (2017, September). EHRs: The challenge of making electronic data usable and interoperable. P & T: a peer-reviewed journal for formulary management. Retrieved February 8, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565131/
[6] Ventres, W., & Shah, A. A. (2007, May 1). How do ehrs affect the physician-patient relationship? American Family Physician. Retrieved February 8, 2022, from https://www.aafp.org/afp/2007/0501/p1385.html
[7] What are Electronic Medical Records? (EMR meaning). USF Health Online. (2021, November 17). Retrieved February 8, 2022, from https://www.usfhealthonline.com/resources/health-informatics/what-are-electronic-medical-records-emr/
Kaitlyn Bali is a third-year Computational and Systems Biology major at UCLA. Sophia Dinh is a third-year Molecular, Cellular, and Developmental Biology major at UCLA. Kaitlyn and Sophia are both THINQ 2021–2022 clinical fellows.
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