Why are physicians less efficient with EHRs?

There have been multiple studies, articles, and blogs written concluding there is an increased inefficiency when physicians, hospitals or offices are converted to electronic records. Multiple surveys ask the question: “How has the EHR affected the number of patients you provide for during the day?” The majority of responses given are usually that it decreases, and many times significantly.1

Why is the efficiency decreased when an EHR is implemented? One of the professed benefits of an EHR is that it will improve efficiency. The reason in many cases is a communication breakdown or disconnect. Experienced physicians have developed their workflow. They have created tools, such as paper forms with checkboxes or dictation systems tailored to how they think, work, diagnosis and treat patients. The processes each physician develops are very similar, but like snowflakes very few are identical.

The differences may not even appear as differences. One physician may provide a narrative for a section of his note, another physician may have an acronym for that same section. Sections of the note may not be identical. Sections of the note maybe in different orders. The amount of customization of each EHR is variable, but that variability is either inadequate or not taking advantage of its full potential.

Many EHR’s are very configurable. This may sound like a good thing. But to a user who is not accustomed to working with the computer as a tool, this configurability is very intimidating and may not be fully explained during deployment of the software. Because of this the user adapts to the software, rather than the software adapting to the user. Workflows that have taken years to develop are scraped.

New doctors who have not developed these workflows more easily develop them to conform to the software and hence improve efficiency more quickly. But the mobility of many new physicians leads them to different software and in turn new workflow.

What can be done to improve EHR efficiency? Along with transportability of personal health information, they provide a framework to allow transportability of workflows for physicians and staff. This will require a governing body to provide guidelines, and establish standards. Not standards in the sense that every doctor must record blood pressure a certain percentage of the time, but standards in the sense that one vendor’s template can be interchanged with another vendor’s template. The workflow that the physician or staff creates can no longer be held “hostage” because it’s incapability with another vendor’s software.

Vendors need to develop intuitive “programming” languages to create these templates. These templates could be modified and improved upon by the end user. This will allow end users to quickly create, refine or convert their existing workflows.

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