I read the article about electronic health records ("The Doctor Won't See You Now," Aug. 11 Forum) with great interest as the EHR is the major reason I am leaving practice. Although exchange of information like laboratory data or radiograph assessment is much easier using an EHR, the time commitment to complete the medical record with all the additional requirements is onerous.
For every visit, I must record a chief complaint taken from a drop-down list rather than in the patient's own words, then move to a different screen to complete medication documentation, then a different screen to check health maintenance issues like immunizations, then a different screen to complete an office note, then a different screen to complete a diagnoses and orders list, then a different screen to complete letters or notes to appropriate consultants, and then a different screen to complete a level of service taken from another drop-down list and a follow-up plan.
My comments just touch on the many other requirements in the EHR, many of which like family history used to be completed by the patients rather than by me. In the past I used to do all those tasks simply by speaking into a hand-held dictation cassette and relying on my support staff and the patients to supply necessary data. As a result, information like family history or past surgeries is often missing from the EHR. The time to complete a single note has markedly escalated.
As a teacher in a residency training program, I am certain that the residents spend much less time with the patients. That unintended outcome of EHR use is difficult for both the public and physicians to accept. However, the real question is whether EHR use improves outcomes. Are patients less ill when EHRs are used? Are lives prolonged? If so, under what circumstances? Many technological advances reduce human interaction (witness CT scans) but result in better outcomes. Medical recording will never revert to paper charts. So in my book what needs to change is how the EHR is used and streamlined.
One of my colleagues told me that my problem with the EHR is similar to the problems the auto industry had when it was in its developmental stages. He said we are now driving a Model A EHR. I sure wish I had a good Jeep.
DONALD B. MIDDLETON, M.D.