I recently read an article by Dr. S.D. Madduri, called Life With and Without EHRs. Dr. Madduri outlined his journey from paper-based to digital medical records in an edition of Medical Economics published a few months back. I am personally obsessed with end users of healthcare technology. I often find myself asking my own healthcare providers questions about how they use technology while I’m sitting in the exam room myself. This interest is what prompted me to start planning an upcoming podcast series where I interview physicians about their experiences with healthcare technology. Stay tuned for that.
What I found particularly interesting about this particular piece was that Dr. Maddura originally worked with EHRs for five years before switching to a practice that still used paper-based medical records. He then worked through the transition of moving that rural practice into EHR. My original conception of physicians were large networks of doctors working for hospitals. In reality, most physician practices are small practices that comprise only 3 physicians on average. In 2010, only 10.5% of those small practices had EHRs that were considered “fully functioning” (not to be confused with meaningful use).
Many of the achievements in healthcare technology, business intelligence and collaboration for example, rely completely on electronic records. So, it’s pretty interesting when you consider the change management issues surrounding EHR adoption. Even with their drawbacks, paper-based records are still preferred by the majority of physicians.
This makes it important to understand healthcare technology implementation from a physician’s perspective. In his article, Dr. Maddura outlined the following advantages and disadvantages of EHR from the physician perspective:
Advantages
- Electronic Perscriptions: EHR helps physicians avoid pharmacy-related mistakes by informing physicians of all available prescriptions available for a particular diagnosis along with recommended dosages and potential drug interactions. If a doctor inputs a prescription that may prove harmful to a woman who is lactating, for example, an alert will be prompted. All of this information can then be sent directly to the patient’s pharmacy, which makes things easy for the patient as well.
- Up-to-Date Information: One thing I hear from many physicians is that they love having immediately updated information related to treatments, laboratory tests, and diagnosis. All physicians working on a particular case can view updated information simultaneously. Interoperability with devices provides physicians with the ability to access information remotely.
- Reminders: Similar to intuitive prescription information, EHR systems provide enhancements to preventive care by reminding physicians of tests or examinations that are necessary.
Drawbacks
- Can Increase Physician Workload: Like it or not, the implementation of any technology, particularly one as important as electronic medical records, brings with it a steep learning curve. Dr. Maddura mentioned that it took his organization 3-6 months to get used to their new system. Some nurses quit the practice due to the stress. Since the physicians were new to medical records, it took approximately 10-15 minutes longer than usual to find the information they needed. Since they needed to add additional time to each appointment to accommodate this change, their patient load, and their resulting income, decreased in the short term as a result.
- More Expensive than Paper: The costs related to hardware, software, and training can be intimidating to a small physician practice. One can understand the hesitance to transform from a paper-based system when you compare the initial costs. While this is true in the beginning, the real cost savings occur further along down the line when healthcare organizations improve operational efficiency as a result of better data.
- May Reduce Patient-Doctor Interactions: Dr. Maddura’s comment here mimicked information I read recently in How an EMR Emotionally Disengages Physicians From Their Patients on KevinMD. I have some great physician insights to share in the upcoming podcast series on this topic!
- Ethical/Legal Issues: EHR, and social media, create very important issues in terms of privacy data. We dealt with this topic in depth in Protecting Patient Data in an Interconnected Healthcare System.
So what do you think? Are there any advantages or disadvantages that you would add?
