Steven Lippmann, M.D.

The EHR: Pro &  Cons

Some years ago, the electronic health record (EHR) arrived with hopes to advance healthcare, expand research opportunities, and make medical charts readily transferable. These goals were not all realized; to the contrary, the EHR is troublesome for physicians and upsetting to our patients. Some people complain that, “my doctor hardly looks at me.” In its present form, with EHR’s lengthy irrelevancies and “box-clicking“ burdens, psychiatrists must often work extra hours just to keep up with clinical record-keeping.

This results in frustrations partly responsible for escalating physician burnout and patients feeling ignored. Just complaining does not help – actions speak loudly – here are suggestions for how to remediate the EHR, while augmenting clinical contact.

For You

While our profession works to improve the EHR, take responsibility to reduce your stress with attention to your own personal life-style, sleep, and health care. Maintain a balanced work and home schedule, with exercise, avoiding chemical dependencies, and also enhance your typing expertise.

Because computerized charting is so laborious, direct patient contact suffers – really bad for psychiatry. So that current charting will not interfere with interpersonal relationships, be sure to maintain frequent eye-contact, handshakes, and similar engagements. A sense of humor helps.

Clinical practice is now complicated by more multitasking, so prior to appointments, be updated about details of history and issues likely to present with each person. Despite time-pressures, whenever feasible, there are advantages to complete charting on each case before beginning another one – quicker in the long-run and with details more surely recorded.

Your Practice

Together with your staff, assure a pleasant atmosphere that is patient-friendly, with easy registration and good social relations. Some physicians like to ask patients to answer questionnaires before their visit; that data can technologically populate into the EHR. To facilitate record-keeping, some practices begin charting by physician-extender staff, offer voice-dictation of clinical notes, and/or employ scribes.

Colleagues charged with being EHR-savvy can teach their partners up-to-date tips about better charting, avoiding errors, and proper coding. A practice at the computer diminishes stress; it also helps doctors be faster, more optimistic, and thus more efficient at charting. Positive attitudes result in better clinical relations.

Your Profession

Medical societies and psychiatric organizations can also help us cope with the present EHR while working to improve future record-keeping. State, regional, and national group should also schedule computer training at medical meetings.

Organized medicine can in addition influence elected representatives to revise the EHR.  Deliver to them practical advice at making the medical record shorter, more efficient, and with less irrelevancies and laborious “box-clicking.” Included would be updating regulations and government and/or insurance requirements to diminish “busy-work.”  Our patients, our society, and most physicians would be appreciative of such an upgrade, maybe even improving clinical outcomes.

Our Government

Professional organization recommendations should come from our membership. We best understand the issues, and should ask for a shorter, more pertinent medical chart that preserves human contact with patients and is easier to complete and read or transfer information. Doctors can then focus more directly on our patients. Executive and legislative bodies have the power to make such improvements.

A well-revised EHR is our goal. Benefits are global.

Readings

1. Robinson KE, Kersey JA. Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout. Medicine 2018, 91:38(e123419):1-5.
2. Guo U, Chen L, Mehta PH. Electronic health record innovations: helping physicians-one less click at a time. Health Inf Manag 2017, 46(3):140-144.
3. Megs SL, Solomon M. Electronic health record use a bitter pill for many physicians. Perspect Health Inf Manag 2016, Winter:1-17.
4. Fogarty ECT, Winters P, Farah S. Improving patient-centered communication while using electronic health record: report from a curriculum evaluation. Int J Psych Med 2016, 51(4):379-389.