Can EHR and Physicians Ever Be Friends?

By Lucy Berrington, MS, and Sarah Ruth Bates, MBE, MMS Government Relations and Research Analyst

The electronic health record (EHR) arrived with high hopes, but many physicians associate it with deep despair. Heralded as a way to improve physician practice and patient care, EHR quickly took the blame for burdensome tasks and rules, and disrupting provider-patient interactions. The electronic record epitomizes physicians’ “complex and often adversarial relationship with technology,” says Andrew Schutzbank, MD, MPH, vice president for product and technology at Iora Health, an expanding primary care network headquartered in Boston.

In the conversation about physician burnout, many invoke EHR as a culprit. “My sense is that the current dysphoria in medicine revolves a great deal around the electronic medical record,” said Abraham Verghese, MD — a Stanford University professor of the theory and practice of medicine — at a Medscape event in July. The EHR contributes to (and reveals) “time bankruptcy,” a source of declining self-care among some physicians, says Steven Adelman, MD, director of Physician Health Services at the MMS: “One of the profiles of physicians who get referred to PHS is a doctor who cannot complete his or her charts on time. This doctor characteristically has a backload of hundreds of charts.”

Health care innovators are exploring ways to salvage the relationship between physicians and EHR. “How do we turn EHR into your friend, not your foe — a tool, not a burden?” asks John Halamka, MD, MS, chief information officer of Beth Israel Deaconess Medical Center, who co-authored an NEJM Perspective article in August on where EHR can go from here. The solutions are emerging from third parties, rather than traditional EHR vendors, he says. Popular tech goals of the moment include enabling mobile devices to interact with EHR, building secure communication capability within care teams, and facilitating clinical decision support.

Turning Data into Wisdom

“I try to create tools that turn data into wisdom,” says Dr. Halamka. He and his colleagues are piloting an app, BIDMC@Home, that gathers patient-generated data (for example, blood pressure readings and body weight), incorporates it into the EHR, and interprets it for clinicians, generating alerts as necessary. They have also created health care applications for ambient listening devices, such as Amazon’s Alexa, with the goal of accessing seamless support in care settings for both providers and patients: “In a room with a patient, you can get a blood test, bring in a nurse, get a social worker.” (During our phone call, he asked Alexa what was coming up that day, and she listed his upcoming activities.)

Other projects include reinventing the EHR almost from scratch: think of a new generation of EHR bred and raised to be kind to physicians and patients. At Iora Health (slogan: “Restoring humanity to health care”), a collaborative care platform, Chirp, is integrated in the entire care experience — either “through Chirp for Patients, available on any device, or up on the monitor on the wall of an exam room,” says Dr. Schutzbank. “This way, we are able to bring patients into their record, allow coaches and providers to focus on patients instead of keyboards, and have a resource for teaching and discussions.” Chirp is far from reaching its potential, he says, yet “the perception from our physicians is that in many ways it is light years ahead of anything out there.”

Reclaiming Physicians’ Time

Alternatively, EHR might be redesigned so that patients and physicians barely see it. “We want to make the technology as invisible as possible. If they didn’t notice the EHR in the room, our mission would be accomplished,” says Kevin Tolin Scheper, vice president of customer performance management at athenahealth, which develops network-enabled systems and services for health care providers.

The raison d’être of the company, he says, is to eliminate tasks that divert physicians from direct patient care. Their cloud-based platform, athenaClinicals, is designed to automate certain processes, delegate appropriate tasks, build shortcuts into workloads, and handle administrative demands, such as organizing incoming faxes. The platform has 100,000 active providers. That reach enables “deep visibility” into how physicians and staff engage with it, helping to identify best practices and sources of physician dissatisfaction, says Scheper. When physicians struggle — spending a disproportionate amount of time on charts, for example — the platform offers an intervention, which can take the form of emails, popups, phone calls, or 1:1 coaching via screen share and webcam. “Our goal is to help physicians regain control of their time by optimizing the way they document care. They can use their newfound time to spend more time with their patients, see additional patients, or go home on time,” says Scheper.

EHR-physician rapprochement is a long-term goal. Any proposed solution may create new questions or pressure for additional resources. The Iora platform is designed around patient encounters involving two providers (for example, a physician and a health coach), and the oversight embedded in smart systems may, to some physicians, signal the loss of professional autonomy that is itself associated with burnout. Nevertheless, the healing process is underway.

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