Much has been said about the failures of electronic health records. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. We use IT via computers or smartphones daily for social, financial, or consumer aspects of lives. Health care has lagged behind other sectors of society in the adoption of digital technology because of regulatory issues, cost, and resistance to change. There are many positive aspects of EHRs, some more obvious than others.
They are what patients expect.
Patients live in the digital world. Seventy-eight percent of office-based physicians use an EHR, according to a study in the journal Health Affairs. Patients expect that their test results and records are easily accessible by all their providers. The promise of interoperability – the easy digital transfer of data from one data source or EHR system to another – has yet to be realized. This is one of the fundamental potential benefits of digital health technology. HIMSS, an advocacy organization focused on better health with information technology, has sent to Congress its recommendations on achieving interoperability within the next 3 years. This is a pivotal issue in creating the EHR envisioned by both patients and physicians.
They can be used to mitigate risk management.
Adoption of any significant change in health care practice presents challenges specifically with regards to risk management. HIPAA privacy regulations and security are of paramount importance. Most risk managers deal with legal issues after an incident has occurred. Digital health technologies can also potentially mitigate risk.
They can (Yes!) enhance the patient encounter.
While many physicians believe that EHRs destroy the patient encounter, there is another way of viewing the interaction. It all depends upon how it is presented in the office. The computer screen may impede the all-important eye contact between the physician and patient (either because of the physical presence of the screen or the physician’s persistent gaze at it). This is a surefire recipe for disengagement and subsequent destruction of the patient-physician relationship. However, the introduction of the computer (asking permission to use it) with physician and patient triangulated with the screen produces a care team atmosphere. Demonstrating the EHR’s functionality while highlighting pertinent clinical information provides a positive experience for both participants.
They brought health care into the digital age.
EHRs are not the face of all of digital health technologies. They do represent the hub around which other technologies need to flow, because this is where the patient interfaces (pun intended) with the physician. Digital technologies will enhance patient engagement. EHRs are the first experience many physicians have with digital health technologies, and they have yet to fulfill their intended goals. They are in their first iteration. Physician groups and health care enterprises have made themselves heard to the EHR vendors and change is coming. Other digital health technologies are here and will improve health care on many fronts. They themselves will transform the EHR into a more useful clinical tool, which will increase patient education, engagement, and connectivity.
They will be much different and better in the near future.
The American Medical Association got it right, in my opinion, with respect to its recommendations for design overhaul of EHRs. The organization outlined an extension of its study with the Rand Corp. and listed priorities of what should constitute design overhaul of the EHR. These include the incorporation of tools that support team-based care, promotion of care coordination among providers, product modularity and ability for configuration, the reduction of cognitive workload, the promotion of data liquidity, the facilitation of digital and mobile patient engagement, and the ability to expedite user input into design and postimplementation feedback.
As digital technology becomes a more substantive part of health care, there will be a need for physician IT champions who can make this process easier and more fulfilling for others. I look forward to seeing this happen.
Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.