Could Reduced Physician EHR Use Improve Quality Healthcare?

HM Epstein hmepstein at GMAIL.COM
Thu Aug 18 16:58:20 UTC 2016


​​Are EHRs hurting proper Dx evaluations or are they helping? ​

In an op-ed in JAMA entitled, "Evolutionary Pressures on the Electronic
Health Record-Caring for Complexity" the authors talk about
​the​

dangers of
​diagnostic errors when ​
clinicians' focus on the computer screen instead of the patient in front of
them and the inadequac
​ies
y of the EHRs
​as learning tools
..
​I've attached the JAMA piece as a pdf and have included the article
about it
​ ​
in *EHR Intelligence *below​
​.​

Best,
Helene


https://ehrintelligence.com/news/could-reduced-physician-
ehr-use-improve-quality-healthcare

Could Reduced Physician EHR Use Improve Quality Healthcare?

Despite some of their benefits, reducing the emphasis on physician EHR use
may be key to improving patient care.
[image: physician-ehr-use]

In a recent op-ed
<http://jama.jamanetwork.com/article.aspx?articleid=2545405> published in
the *Journal of the American Medical Association*, authors Donna M. Zulman,
MD, MS, Nigam H. Shah, MBBS, PhD, and Abraham Verghese, MD, highlight the
pitfalls of the EHR, arguing that the healthcare industry should decrease
the importance of EHRs in an effort to preserve certain elements of quality
care.

“Deimplementing the EHR could actively enhance care in many clinical
scenarios,” the authors wrote.

“Simply listening to the history and carefully examining the patient who
presents with a focused concern is an important means of avoiding
diagnostic error. Many phenotypic observations… change the diagnostic
algorithm and are easy to miss when work revolves around the computer and
not the patient.”

Physicians need to look away from the EHR screen during care encounters and
better assess the patient on an individual and personal level. In doing so,
the authors said, physicians can catch certain characteristics of symptoms
that may not have been recorded in the EHR.

“What is the *story* of the individual?” the authors asked, noting that
providers should look to uncover this question during each care encounter.

“The most sophisticated computerized algorithms, if limited to medical
data, may underestimate a patient’s risk (eg, through ignorance about
neighborhood dangers contributing to sedentary behavior and poor nutrition)
or recommend suboptimal treatment (eg, escalating asthma medications for
symptoms triggered by second-hand smoke).”

The resolution to this issue could also lay in better electronic
information capturing. Through patient portals
<http://patientengagementhit.com/features/how-patient-portals-improve-patient-engagement>
and other digital communication tools, physicians should be able to gather
individualized patient information about their geographic environment or
lifestyle choices. EHRs, however, have not caught up to this point.

Lagging EHR sophistication brings about a whole bevy of problems, the trio
said. These technologies have yet to successfully integrate information and
synthesize it in a useful manner, making them less functional in the actual
care setting. Should EHRs be able to aggregate information and display it
in an efficient graphic manner, for example, they may be of more use for
providers.

Although many EHRs are starting to incorporate predictive analytics
<http://healthitanalytics.com/news/four-use-cases-for-healthcare-predictive-analytics-big-data>
functions, many of them still are not useful in improving quality care. The
authors suggest functions that allow providers to compare patients in the
moment.

Seeing how certain hypertension treatments have worked on similar patients
is more useful for providers than understanding the likelihood that the
patient will develop another condition along the line, the three explained.

This massive amount of data – which is often disorganized – brings about
another issue: alert fatigue. With many patients suffering from a litany of
chronic and acute conditions, EHRs are producing a number of alerts and
reminders and providers are inundated.

“Better triage of EHR alerts and fewer workflow interruptions are needed so
the physician can maintain situational awareness without being distracted,”
they authors wrote. “Outside of health care, other sectors have found
suitable solutions for this type of challenge: the airline industry limits
pilots’ audible alerts to critical and life-threatening events, and
financial software enables users to set investment goals without inundating
their inbox at every price fluctuation.”

As they stand now, EHRs are standing in the way of improving quality
healthcare because they are not seamlessly integrated into physician
workflow
<https://ehrintelligence.com/news/4-ehr-best-practices-for-improving-clinical-workflows>,
the authors explained. The technology causes pauses in workflow, and put a
strain on providers.

“There is building resentment against the shackles of the present EHR;
every additional click inflicts a nick on physicians’ morale,” the authors
concluded. “Better medical record systems are needed that are dissociated
from billing, intuitive and helpful, and allow physicians to be fully
present with their patients.”

Going forward, the authors explained, the EHR industry will need to catch
up with technological trends. By adopting better methods to prioritize
digital reminders, represent information, and collect qualitative patient
data at the point of care, EHRs developers can help make these tools more
functional within the physician practice.






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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