Why Doctors Hate EMRs

Why Doctors Hate EMRs
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Today our lives are surrounded by technology and electronic devices. With just one click we can access information of whole world. Health system has also been digitalized in the past decade. New systems have been introduced into the health care to enhance the efficiency and efficacy of the health industry. The most noted system is EMR electronic medical records. So far it is considered the best system software as it consists of previous and present medical history of the patient with accurate notes that can be accessed anywhere in the world, but there are some characteristics that make doctors absolutely hate it.

What is Electronic Medical Records?

EMR in other words Electronic Medical record is a real time health information system, that is patient centered and focusses on making health information available to other health providers more securely and easily accessible.

It is built to share medical data between health care providers and organizations, including radiology/ pathology labs and other health care departments, helping in early diagnosis of the patient’s medical condition. The EMRs contain:

  • Patient demographic
  • Medical history
  • Personal statistics
  • Medications/Treatment plans
  • Allergies
  • Immunization dates
  • Radiology images
  • Lab and test results
  • Vital signs
  • Administrative and billing data

What really does make EMRs hateful to doctors?

Doctors are the frontline users of the system software; they are the most critical users. As their focus is intended towards the health of the patient. However, when the doctor enters a medicine in patients record the system suggests other medication options considering past conditions entered in the system. This causes a problem as sometimes we need to treat the present condition to stabilize the patient.

Another problem arises with the system is bugs, viruses and slow system, sometimes the system hangs or just simply stops working but a provider needs to enter the data as soon as possible with all the busy schedule and on time assessment of patient. This slow system causes disruption in the workflow. It is absolutely dreadful to just wait for the system to get fixed. Due to this reason a lot of information gets misplaced or deleted from the system. This may cause a huge problem if a single detail from patient’s history get missing which could cause misdiagnosis. Physicians and doctors are trained in a way to treat patients and they hate paper work or documentation, its dreadful and drains clinical time as the doctor spends more time on screen than with patients. Stanford university in contribution Mayo clinic conducted a survey according to which 44% of doctors who use EMRs and CPOE were unhappy and said that it caused physician burnout.

Most of the EMR programs are built difficult to understand. Providers and doctors have to take out extra time to understand the system. This causes burnout as they are already exhausted. Another problem that doctors face is complex User interface of the software. They need to enter the information quickly but the UI system makes It difficult to do so. Other cons of this system include:

  • Too many options to choose from
  • Patient misidentification, a lot of times there is misunderstanding or wrong information entered the system, this causes inaccurate patient identification and administration of wrong treatment.
  • Another problem includes duplication of records, there could be a fair chance that two patients might share the same record. This increases the risk of patient safety. Many other issues include denied claims and low quality patient data.
  • Time wasted during signing in and out
  • Lack of interoperability with other hospitals, the most important part of EHR was accessibility of information domestically and internationally. But the software’s in majority of the hospitals lack inter-telecommunication system. This causes a stir when we have to refer a patient from one hospital to another. The only mean of sharing information is via phone call, screenshot, fax or printing out the necessary documents
  • Increased number of clicks while entering data, doctors need to enter prescription quickly with minimum number of clicks per entry.
  • Some systems are designed in a way that all the required options are displayed on screen. However, there are too many option to choose from and it takes a long time to find what you are looking for.
  • While entering medications the system suggests the drawbacks and side effects of every drug compared with the past and present illness of patient, this includes any minor detail, doctors don’t want to know all the side effects and click their way through it. They just need to enter the information without any changes in done by the system.
  • Designing charts and graphs for the morbidity of every patient and outcome of every medication given. This takes a lot of time and effort.
  • Copy and paste same information over and over again every time a physician enters a medical record.
  • Unable to edit information once it has been entered in the system.
  • Too many systems! There is a separate system for every record e.g. for letters, lab results and findings, prescribing medications, ordering tests, chemotherapy results etc. this causes information to scatter in different software’s and the provider or doctor sometimes has to go through all of these and many more to get the desired information they need. Developers are designing system to reduce it to 3 per patient.
  • Providers and doctor’s wat to know if the lab results are here and in what form they are saved without going through a series of questionnaire.
  • Most physicians have reported that EMR is highly expensive to invest in their practice, but overtime it has become a necessity. The development cost is too high and then training sessions have to be conducted to train the medical staff to use the new system
  • Around 66% of physician have reported that the EHR system they invested in contained a lot of bugs and lack of availability of certain function which forced them to enter data below their expertise.
  • With all the data being entered over the course of many years there is data overload in the system causes it to lag while entering further information.
  • The information is more prone to hackers, although a close security system is integrated and only few are given access to it there are high chances that the system can be hacked and information could be leaked.

EMR has changed the whole idea of storing and interpreting data in the health care industry, with EHR physicians and doctors are able to go through huge amount of information quickly without searching from huge piles of notes. At the same time new prescription can be added with ease and is readily available for the patient to administer. The approval process is speed up, multiple providers and physicians can look at the documentation of patient.

EMRs are also referred as Practice management system, because it’s more than just a patient or client record it’s actually a whole way of organizing your practice records, your notes and schedule on one platform.

Developer and doctor dichotomy

Of course EMRs have enhanced the health care industry but as much as EMRs have provided benefits and improvements in the healthcare industry, at the same time it has added a lot of challenges and problems too. The goal of EMR was to reduce error but its complex UI system has increased the chances of it. As the issues that I’ve mentioned before continue to exist and there is no improvement so far.

I do agree that EMRs sucks and physicians all over the world hate to use these systems but are we going back to paper notes? I don’t think so! The only way to make it a bit easy to use is by stepping up and letting the developers know what do you want and how do you want the system to be built.

The real problems lie between the miscommunication and misunderstanding between the developer and doctor. As the developer is unaware of the health care system, they consider it as a scientific system filled with loads of information. They just don’t know the importance of quick access to information health care.

On the other hand, there are doctors who shifted their career to the field of programming, they haven’t spent most of their time administering patients but somehow think they know it all and end up designing a more complex system containing burdensome language and taxonomies. This causes barrier in obtaining a clear picture of your patient’s disease.

Unfortunately doctors and physician don’t participate in developing these systems but only whine and criticize the system and developer. But we can’t blame the developer here as he is doing the way he is guided.

Do EMRs really contribute in the improvement of health care? Currently majority of the EHR system are used in accounting and billing for health care industry, they have very little part to play in enhancing the efficacy and efficiency of the system.

EMRs have three parts - Calendar; to schedule appointments - Depository of documents; to record medical notes - List of bills; contains previous history records and codes from each diagnosis done by another doctor.

To explain it in simple words EHR is only a software that stores information just like any other electronic device software. It stores the information related to prescription, lab test and surgeries. Which can be easily shared to other health care providers and organizations.

Takeaway

Day by day increasing advancement in technology have given us benefit to access information with just a few clicks. This technology is now also applicable in health care industry that enhance the knowledge and communication within different health care sectors and organizations.

Special integrated clinical workstations are built and a platform is provided to organization work in conjunction with health care industry, this enables them to access the patient data, investigate and administrate the drugs being given and approve the prescribed medication in just a few steps. One system most widely used is EMR, electronic medical record. It has transferred the healthcare industry from paper records to electronic record in the past decade. It has gathered data from scattered information on pages to one platform and made accessible to everyone in the department. It has also helped in the management of large amount of data combined from all healthcare sectors. With EHR immediate availability of patient’s history and information to health care providers is made possible, including getting the summary of patient’s history of disease and medications, lab result reporting, diagnostic test and clinical decision making.

However, with all these benefits comes some disadvantages too! With so much information being entered in the system daily and updated every two hours, there could be possibility of errors in the system. As the system is designed in such a way to not erase anything once entered, any sort of wrong information, wrong terminology or misunderstanding can lead to misdiagnosis of the patient’s disease.

Errors in medication or changes done by automated system can also cause wrong entry of patient’s data. The EMRs are designed to let the provider or physician know every detail about patient’s history including minor illnesses and drug to drug interaction, often times the system forces the physician to change the administration certain drug due to a minor complication found in patient’s history. This causes burnout in physicians as it takes more time than usual to enter your desired information. Further the user interface is difficult to understand and requires more clicks to get through your desired option. Another problem that most physician suspected is misidentification of the patient may due to similar names. All of these errors and problems cause exhaustion and take more clinical time than usual. Most of the doctors have to spend more than 2 hours on single patient to enter the data. The adoption of EMR in health care sector is still under development and requires a lot of improvements in the software like customization, user interface, data entry issues, data sharing, data security, data accessibility, enhancing non computer expertise, reducing burnout and clinical time spent on screen and reducing financial investment in the software. It’s a long route to take but with team work a more efficient, time and cost saving system can be generated.

References

https://www.thehappymd.com/blog/bid/351428/9-reasons-physicians-hate-emr-the-2013-rand-study

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

https://www.chartlogic.com/blog/why-doctors-hate-emr/

https://www.healthleadersmedia.com/innovation/death-thousand-clicks-where-electronic-health-records-went-wrong

https://medcitynews.com/2016/02/physicians-hate-ehrs-infographic/