In response to our request for comments, readers have graciously flooded our inbox with a variety of e-mails full of opinions on electronic health records.
This has been an overwhelmingly positive and educational experience. Through your comments, we have been reminded that health information technology is a field rife with debate. Here, unlike most other areas of medicine, it is still impossible to define a single best practice that can reliably be employed in every EHR implementation.
Although we are convinced that it is the timeliness of the subject matter that actually drives readership, we truly appreciate the personal words of affirmation we receive every month. And though we do try to respond to feedback individually whenever possible, we think it is important to again say thank you to everyone who has cared enough to read and respond. You help us to better navigate the murky waters of electronic health records and help make sure that our comments are grounded in the day-to-day experiences of a wide range of users.
Over thenext few columns (with the permission of the authors), we will be publishing many of the comments we have received. Not surprisingly, the majority of messages discuss negative experiences, with an occasional e-mail that speaks to the benefits of the EHR. The focus has really been on how the transition to electronic health records has changed the physician/patient experience and the efficiencies – or inefficiencies – introduced by the use of EHRs. Many respondents expressed appreciation for the opportunity to vent their frustrations, and this further underscores the need for better, more open discussion on the topic.
One letter that reflects a balanced sentiment, yet captures the overall flavor of the thoughts expressed by our fellow physicians, came from Dr. Marc D. Grobman, a solo family physician in Wilmington, Del. Dr. Grobman adopted Practice Fusion, a free ad-supported EHR that we mentioned in a previous column. He relates his experience before and after the EHR, and how it has affected his practice:
"So let’s start with my routine before EMR [electronic medical records]. I would arrive at the office at 8:30 a.m. after seeing my kids off at the school bus. I would greet my staff and start seeing patients at 9:00 a.m. During the day, messages would pile up in the little basket for me, and I would quickly jot answers to questions or requests and hand them back to my staff between patients. During lunch, I would quickly eat ... and then jump to the mail, sign everything then enter into a Word file for the patient (the poor-man’s EMR) and then bring it to the staff for filing. The filing would often take days to accomplish because, being solo, I have only two other staff members.
"Now my days at the office begin at 7:45 a.m. (after rising at 5:30 a.m. to shower, eat, and check the EMR for prescription renewals, use the Delaware Health Information Network [DHIN] to look for admissions to the local hospitals and download the lab results, H&Ps, consults, radiology reports, and so on) with a grab of incoming faxes off the fax machine. I then race to my desk and turn on the computer and scanner to scan everything. Then I race to upload the material before the patients start at 9:00 a.m. Between patients, or most often at lunch, I answer "Messages" on the EMR, write Rx’s and handle any other things that come up. During lunch I also take time to scan and upload as quickly as possible. Same routine after lunch. Before I go home @ 6 or 7 p.m., I make sure everything is scanned so I can upload after dinner at home. No filing any more for the staff, since I scan and upload everything."
On first glance, Dr. Grobman’s experience seems quite discouraging, as he has seemingly transitioned his job description from physician to staff. He even goes on to admit being "baffled" by trying to find any meaning in meaningful use. But his closing thoughts do not express regret. Instead, he shares this:
"I do like using the EMR. I like being green and not needing paper, files, folders, stickers. ... I do find it worthwhile to have [an electronic] copy of the paper forms I do fill out for prior authorizations or pre-exclusion questions or legal request-just in case, you know, someone on the other end loses it. Is the trade-off worth it? In the end I am just more than slightly positive about this whole process."