EHR’s (otherwise known as Electronic Health Records) are getting to be ubiquitous in clinics across the country. Thanks to both incentives (yay!) and mandates (ugh), the healthcare field is finally taking the leap that we in banking/finance took nearly two decades ago and moving to an operating system that is built around electronic records, rather than paper. I recently attended a luncheon with the President of our company and several long-time staff members, and it was interesting to hear them reminisce about the old days towards the end of the meal. Stories about processing data using punch cards, nightmares of having to run customer balances all over again after a printer malfunction and calling all-hands-on-deck to fold, stuff and stamp envelopes, and several awful scenarios involving couriers who actually drove to the banks to physically pick up checks, resulting in customers having to wait days for their funds to clear. Since I studied history and worked in museums for years before coming into this field these stories were not as surprising to me as they were to others at the meeting who are also under age 35, and had never before considered a time before electronic data processing.
Of course banking doesn’t work like this anymore. Everything is done electronically, and files are moved across the country in seconds. The reason that they are able to do this is because everything is done electronically, inside a core system. A bank may still run tickets to move funds around, but those tickets are either scanned into the core for electronic processing or the transactions are entered directly into the core from a computer. The idea of trying to run a banking operation without some kind of software-based core system is unimaginable. The only question for a bank becomes which software-based core system to use, not whether one should be used at all.
Healthcare is just beginning its first transition into a software-based core operating system, and just as the banking sector experienced, there will be some bumps in the road. But one thing you will hear frequently from hospital staff and from vendors is that “Doctors HATE the whole EHR thing…ours would rather go back to paper charting.” Reasons for this vary depending on who you ask, but they usually include some form of “It’s negatively impacting our workflow” and “It’s not efficient for what we need” and “It’s too damn expensive” and “It’s too complicated”. Are all of these issues that need to be addressed by both the healthcare system and especially by software vendors? Absolutely.
Michelle Ronan Noteboom, who specializes in healthcare IT strategy, marketing and communication, asks a much more interesting question in a recent blog post on Healthcare IT News. Her question: Does it matter if doctors don’t like EHR’s? It makes you gasp just to read that question doesn’t it? After all, the EHR’s are made for doctors to use! Doctors are the ones who are treating patients and recording their treatment. Of course it matters if they hate EHR’s! But let’s look at that question a little more.
Michelle starts her article by mentioning some pretty damning statistics, including a recent industry survey that found only 34% of doctors were satisfied or very satisfied with their EHR’s in 2014. In 2010, by comparison, 62% of docs were satisfied or very satisfied, so that’s quite a drop. Other numbers from the survey indicate that 72% of doctors reported that EHR’s made it more difficult to decrease their workload (which is supposed to be one of the benefits of using an EHR in the first place) and 43% cited productivity challenges that they have not overcome in relation to their EHR system. Those are some pretty scary stats.
Michelle then goes on speculate that some of the factors influencing this drop may include things like Meaning Use Requirements (essentially in 2010 those using an EHR were more likely to be doing it by choice, whereas in 2014 use had been mandated so clinics who were hostile to the idea of EHR’s were forced to begin using them), Usability Issues (Social media and smart phones are light years ahead of most EHR software in terms of ease of use and intuitiveness, and if you are used to something like that it is painful to have to use software that can only be described as clunky by comparison) and poor ROI. But she then points out that if you look at the data in the survey, there is a large jump in satisfaction that occurs around the 5 year mark of usage; those who have used their system for less than 5 years tend to be very negative, while those who have used it for more than 5 tend to be more positive.
This observation is one of the key factors in her argument that it doesn’t really matter whether doctors hate their EHR’s. Because we have so many novice users in the field, there is a greater proportion of those who have less than 5 years experience, and are thus weighing the overall numbers toward the negative. Give it a few years, she says, and you’ll see the satisfaction rates rise. She also points out that there is likely a bit of not being able to see past the end of your nose going on in this case. EHR’s, she argues, are the backbone of a system that is going to allow better patient care at every facility, no matter where you go. But a system like that needs data to be useful, and we are only at the beginning of data collection. Physicians may be unhappy with the results of their efforts as they stand now, but the true payoff is 5-10 years down the road.
I happen to agree with Michelle on her opinion that physician satisfaction with EHR’s doesn’t matter, but I only agree with her up to a point. I do think that right now trying to measure physician satisfaction is a bit of a waste of time. The bottom line is that doctors are not going back to paper charts. It is impossible for them to submit claims for payment and reimbursement that way, let alone meet compliance guidelines. It would be like asking a bank to go back to hiring a courier to take a copy of everyone’s checks to a data processing center hundreds of miles away for processing. They will look at you as though you have lost you mind, because you have. Too much has changed to go back now.
I also agree that it would be a mistake at this point to start trying to design EHR systems with the sole purpose of pleasing physicians. Trust someone who has worked in a similar industry for several years…you cannot please everyone. Trying to change your system to accommodate the needs and wishes of one person, or even one medical system, is a lesson in futility. A change you make to please one doctor will inevitably anger someone else. You need to be responsive to customer requests, but not let them rule you.
The EHR’s have bigger issues on their plate right now. A majority of them ARE clunky, resembling nothing much more sophisticated than a glorified Excel Spreadsheet. They are designed by programmers, who design them for ease of programming, not for ease of use for the non-programmer end-user. Then of course you have the interoperability issues, which are well-known. EHR’s need to be focusing right now on these issues.
But once these core issues of interoperability and function are ironed out, I think doctors should have a strong voice in improving usability and responsiveness issues within these core systems. They are your heaviest users, and they are your best resource for finding flaws or inefficiencies in the system that can be addressed for both better satisfaction and better function. That is when doctor’s opinions matter, and they matter a great deal.