Re-imagining the EMR: Three essential and transformative innovations for caregivers in a value-based world.

Posted by David Fairbrothers, ON February 28, 2019

The transformation of the U.S. health care system to a value-based orientation based on evidence-informed practice and patient-centered outcome metrics is accelerating. The EMR is central to this process but current technology simply hasn’t kept pace. Physician burnout is epidemic in today’s health care system. Depending on specialty, 40-55% of doctors reported symptoms of burnout in a recent survey describing loss of enthusiasm for work, increased cynicism and a decreased sense of personal worth. Frustration with dated, antiquated electronic medical record technology is a major contributor to burnout as increased computer data entry consumes precious time better devoted to genuine patient care.

A just-released survey of more than 15,000 practicing physicians on EMR use found 57% reported decreased face to face time with patients. In comparison with 2014 data, more physicians (27%) reported serious dissatisfaction with the electronic record. 64% of doctors in their most productive years (aged 46-55) noted the EMR slowed their workflow. More time spent at the keyboard steals from time with family or restorative recreational activities. In addition to spawning an entirely new health care specialist – the scribe – as a workaround for poor technology, EMR-related burnout is leading to early retirements, career changes, and ultimately decreased access to care. Here are three essential features – “must haves” – which should serve as the guideposts for design of innovative health care technology that really works best for clinicians and patients in the new world of health care: 1. Enhanced ease and accuracy of documentation The core of medical practice is the physician-patient relationship, built on communication, empathy, and physical touch. Neither doctors, nor patients are satisfied when clicking away to complete the note in the EMR is the focus of the visit. As Drs. Gardner and Levinson have eloquently stated in their recent op-ed, Turn off the computer and listen to the patient, “medicine is buckling under the weight of massive, ill-designed electronic information systems.”

The solution is to the make the patient the center of the encounter and not the computer keyboard. Certainly with 21st century technology we can be more creative than pulling a scribe into the exam room to do data entry. Heath care must be one of the few areas where technology has actually increased user workloads, requiring the addition of thousands of new employees just to stay afloat. Beyond the added cost, there is a risk of intrusion on the doctor-patient interaction as a scribe’s presence may inhibit sensitive patient-doctor discussions. A doctor-patient relationship with open, comfortable discussion of the most personal and private issues is central to delivery high quality care with the best outcomes. How about transcription of dictation using voice recognition technology? While seemingly easier and more efficient that clicking away at a keyboard, there is growing evidence that transcription errors are frequent and pose a risk to patients. A recent report of transcription errors in a busy emergency room practice examined a random sample of 100 notes dictated by attending physicians. Almost 15% of the 128 errors identified were deemed “critical.”