The Path to Paperless

Where EHRs Need Some Work

Pinpointing a few specific areas for improvement.

By Peter J. Polack, MD, FACS

Everyone who knows me or who has been following this column knows I am a strong advocate of electronic health records (EHR) systems. Like any new technology, the systems are constantly improving. But, as those doctors who are currently using one know, EHRs are not a panacea. Even with the balance sheet tilted in their favor compared to paper records, we still can identify several shortcomings, ranging from minor inconveniences to potentially serious issues.

From my own experience, and in talking with colleagues who also use EHR everyday, I will pinpoint four problem areas that ophthalmologists find frustrating. Next month, I will discuss the perils of telephone triage with EHR. As electronic systems continue to improve and evolve, my hope is that the developers of these systems will find ways to address these issues and make tomorrow’s systems better.

The Structure of the Chart

The problems with paper records that EHR does address — absence of an audit trail, lack of security, ambiguous structure — also makes these systems more inflexible.

From a medicolegal perspective, this is a good thing. If you have to make a change, you have to add an addendum; you can’t just add to or alter what you entered previously. This process can be especially frustrating if a physician wants to change an impression or plan (or finding) after an employee closes and “locks” the chart.

Some doctors also miss the gestalt view of a paper chart with everything visible at once — problem list, medications, previous procedures, dates of testing — although EMR templates are getting better at this.

Drawing Tools

We have a robust EHR system in our practice, one that is customizable for each doctor if necessary. And the platform has been stable across multiple office locations with only occasional hiccups. But, as a cornea specialist, the one thing that I sorely miss is a decent drawing tool.

Even among other EHR systems out there, the prettier the tool (pre-configured icons, stamps and templates), the less flexible. Conversely, the more options the tool has, the more complicated it is to use. We can choose to opt for standalone software solutions that professional graphic artists use nowadays instead of pen and paper, but, alas, the drawing tools that most EHRs come with leave something to be desired.

Workflow Issues

As I have written previously, generally speaking, the easier an EHR system is to use off the shelf, the more the practice will have to adapt its workflow processes to the software. On the other hand, most larger and well-established practices will usually opt for a more robust and customizable (albeit more expensive) EHR they can adapt to their tried and true efficient workflow processes.

Messaging

Most EHR systems have some sort of internal messaging function that perform better than a paper-based messaging system. But because the messages reside within the EHR, they have to compete for the attention of the user with other features, reports, results and a myriad of other bits of information.

Even with the option of “tagging” a message as urgent or critical, the intended reader can become desensitized to these messages. OM

Next month: Part 2: Perils of Phone Triage

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.