Blog | Friday, September 7, 2012

My struggles with our EHR

My group purchased our electronic health records system (EHR) about 5 years ago. We had four clinical practice locations (soon to be five-and-a-half) with one administration office. None of these sites are close to each other. A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments.

In other words, we wanted to know how our patients were doing in all of our offices, which treatments were working and which were not, and then use this information to refine and practice the best medicine we could. This was the promise of an EHR.

And so my nightmare began. Some of my patients define nightmare as something you didn't wish for and it never seems to end. Volumes could not fully describe my experiences. I'll just mention one "glitch." I noticed that some of my notes were disappearing into the "ethernet" on a seemingly haphazard basis. Sometimes I could locate them in another section of the chart; other times I wasn't so fortunate.

Despite my staff spending weeks trying to find the defect, we had no success. Our vendor monitored my work processes for two weeks. Again, clueless.

To add insult to injury, I was told that I was the only one experiencing this problem which, of course, I took personally. Turns out the problem occurred only when I started my note before my medical assistant entered vital signs. So we had the explanation, but no fix. As a result, I wait for my assistant to enter her data, which frequently delays my ability to see patients on time. Recently, we have added two physicians to our practice. One of them asked me what he was doing incorrectly that caused some notes to disappear. This time I had the answer!! What's more, I was now informed that it was a system wide problem for which there was still no fix.

When I was a kid, there was a TV show called the Naked City. When episodes ended, the announcer said: "There are 8 million stories in the Naked City; this has been one of them." I do know that my story is just one among many. But it's still so annoying.

Because of the flawed design of this particular EHR system, we have been burdened with huge financial costs resulting from lost time, the need for extra IT support, and the hardening of my right carotid artery. I don't need the added stress in this era of decreased reimbursements for providing clinical care and chemotherapeutic agents.

One of my partners has gone back to hiring a transcriptionist rather than using the EHR. Another is chronically behind in his data entry. To this date, we are not set up to pool and analyze our data for outcomes. Soon, we are beginning the gut-wrenching process of converting to a new, and hopefully more user friendly, system.

A few weeks ago, I had the pleasure and honor to have a conversation with Eric Topol, M.D. on "this week in oncology" radio show. We were both intrigued by two articles that recently appeared in the New England Journal of Medicine on this subject. The first, entitled "Escaping the EHR Trap--The Future of Health IT," discredits the myth propagated by EHR vendors that health IT is different from industrial and consumer IT. The authors suggest that vendors have alleged this to be fact "in order to protect their prices and market share and block new entrants."
The second article is also quite enlightening: "Unraveling the IT Productivity Paradox--Lessons for Health Care." In the 1970's and 80's, many industries adopted computers with the expectation that they would increase productivity. To everyone's surprise, digitization resulted in a significant reduction in efficiency. This was called the productivity paradox. Subsequent research revealed that productivity attributed to computerization was underestimated due to defects in measurements, mismanagement of processes (such as summarized in the "glitch" in my system above), and poor usability. Most systems, including mine, don't have spell-checking capability. Unbelievable!!

In chapter 7 of his must read, "The Creative Destruction of Medicine", Dr. Topol discusses the benefits and challenges of electronic health Records and health information technology in detail. Despite the fact that digitization initially can be associated with an increase in errors, which doesn't ease my pain, and many other challenges, he concludes: "While some may consider the topic of electronic medical records prosaic, it should now be abundantly clear that their ultimate adoption and full interoperability will prove fundamental to the future of medicine. Only via full electronic convergence can all the tools of digital medicine be in sync and immediately useful. With the torrent of individualized data flow that is coming from whole genome sequencing, remote physiologic monitoring, and medical imaging, electronic information storage and processing will become more essential than even envisioned today."

I have to agree with him. While this current transition period can be a frustrating, even painful experience, the alternative of a failed health care system is unacceptable.

This post by Richard Just, MD, ACP Member, originally appeared at, a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter. Dr. Just has 36 years in clinical practice of hematology and medical oncology.