Healthcare News & Insights

New questions about EHRs’ effectiveness

No doubt, many people are touting the value of moving toward EHRs. But for all that time, effort and money, how much of an effect do they really have on patient care?

Not much, according to some critics. Despite numerous studies that have indicated a reduction in medical errors after switching to EHRs, reports sent to the Joint Commission have indicated issues with faulty software at individual facilities that resulted in misdiagnosed patients, incorrect pediatric dosages, and  similar issues.

Some clinicians also feel they are losing out on intangibles that improve care because they are spending less time face-to-face with clients, and more time staring at a computer screen.

Do EHRs have more pros than cons? And if so, how can they be implemented to maximize efficiency without harming staff morale or patient care? Share your thoughts in the comments.

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Comments

  1. Thomas Debley says:

    As a patient, I have never been more satisfied with my medical care than I am now as a result of my EHR. I can e-mail my personal physician, set up a phone appointment or arranged on line to see him in person. I renew all my prescriptions on line, get my lab results within a few hours via an e-mail alert to log-on to my provider’s system, and can log on to compare them over time. Recently, I had a potential medical emergency on a weekend. I connected with an advice nurse in under a minute and she had my medical record on her computer screen with up to the minute information including a new prescription that I had had filled only days before. Jointly, we determined I did not need to come in unless my symptoms changed, and then she set up a telephone conference with my doctor, who also was reviewing my record as we talked. When I saw another caregiver recently, she added her observations, recommendations for medication changes and other pertinent information to my medical record and handed me a printout as I left.
    (For full disclosure, I receive my care from a health care system by which I am also employed, Kaiser Permanente.)

  2. I think the healthcare “reform” is missing an opportunity to make a significant leap forward because of a lack of standardization. Several competing organizations have been working on standards for several years and the results and progress is agonizingly slow. The longer we wait to establish standards, the more EHR vendors are going to create customized and “non-standard” processes and medical content to differentiate their own products and services. Currently, there is no (significant) financial or regulatory incentive to reward vendor-vendor cooperation to share medical content (your EHR data). Despite the “announcements”, it will take a long time to reach agreement on standards. The longer it takes, the more resistance to change what has already been created by the EHR vendors because of self-interests and sunk R&D costs. The patient is still left without the ability to aggregate their medical information (and history) in a centralize and organized way.

    Many of the benefits cited by the previous writer (Thomas Debley) is not directly in the realm of EHR but more of a facilitation of communication between patients and various medical providers. Kaiser is a special model and may not be eaily replicated. I am very skeptical of the ROI model for EHR. However, like most new technologies, it will take some inevitable trial and errors to find what works. It is natural to hype EHR as a “magic bullet” to solve the medical costs that plague this country. All of us want to believe there is a “solution” without “pain”. I don’t think EHR will deliver the “hype” results – clinically and financially – that everyone wants to believe.

    EHR is not just a matter of medical content but more importantly, one of process. Until users (doctors and other medical providers) are shown a successful process model, adoption of EHR technologies and its benefits will be limited and slow. I speak with many physicians regarding EHR and the two questions they ask consistently: (1) will I spend less time with documentation / dictation / transcription and (2) will I eliminate costs or make more profits. In an EHR sales meeting, if the answer to the first question is that EHR does not save the physician time, the sales call is “over”.

    I have heard the concerns of clinical people (physicians and nurses) that EHR has detracted from the human interactions (eye contact, body language, expressions) which are intangible qualities that promote good outcomes for both patients and medical providers.

    But this country needs another “bubble” and so, the EHR train will continue to roll. I also predict that most EHR companies will be out of business within a few years. There are too many dollars invested in EHR chasing this market and a “shake out” will inevitably occur. I have already seen several failures from improper capitalization and flawed business models.

  3. Nice post. Seem true on most accounts but I also think that today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.

    Some of the other useful resources on this topic:
    REC’s putting EHR’s to meaningful use
    Certification criteria for EHR

    Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the
    ’safe vendor challenge’ as discussed by many critics.

    What do you all think ?

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