I have been focused on the improvement of the doctor/patient relationship for several years now as I tried to figure out what we can do to improve this dialogue. Even in my own particular case, I have seen how the exchanges between my primary care physician and me had deteriorated over the years and I tried to figure out why. And while I really saw the change begin the first time that she walked into the examination room with an iPad, I was not really acutely aware of the impact on all aspects of how everything has changed at levels that I didn’t even understand since the invention of the electronic health records program that now overrides all of our medical treatment until I came across a couple of articles recently.
Is there any questions left about why our doctors no longer seem to have the time and/or disposition to carry on extended personal discussions with their patients?Barbara Jaocby
The first article was written by a physician (definitely worth the full read) that helps us to understand the process that was needed just to order Tylenol for his patient after he had performed her surgery. He clearly explains how his time and efforts as a medical doctor are being wasted on the work that is necessary to do the data entry needed to process every single step of every single detail of a patient’s visit and treatment and recommendation under the proper code that may not even be included in the requisite options. And what a difference it made on the day that the EMR system was down and how easy it was to write down on a single piece of paper all of the info about the surgery that he performed, the follow up care that was needed, the follow up treatments that were recommended, etc. and be able to move on to talking and interacting with the family without additionally having to type up all of his notes first or having a single interruption by the administrative staff to correct a problem entry.
The second article is focused on the reasons for physician burnout. The following information really caught my eye:
“The EMR and computerized physician order entry (CPOE) have been major contributing factors to physician burnout. Shanafelt et al. report that over 80 percent of physicians now use EMR and CPOE. Physician satisfaction is generally low, with the amount of time spent on clerical tasks of particular concern. Valuable time is taken away from direct patient contact, including history taking and thorough physical examination.
- Other concerns relating to EMR and CPOE are these:
- Physicians spend two hours on the computer for every hour with a patient.
- Fifty percent of time is spent on the EMR, while only 27 percent of time is spent in direct contact with the patient.
- Emergency room physicians average 4,000 total mouse clicks for charting functions and documenting patient encounters during a 10-hour shift.
- EMR documentation requires 6.5 hours per week more than time spent on paper record systems.
- EMR and CPOE compromise focus on the patient (not unlike operating a car while texting).
- EMR design is inefficient and nonintuitive.
- EMR use reduces productivity by 20 to 40 percent.
- EMR use decreases face-to-face communication with nurses, medical assistants, and other physicians.
- EMR alerts are too frequent, and too frequently make no sense.
- For every patient seen in the office, a physician receives a non-visit-related inbox message for another four patients.
Of course, EMR and CPOE are not the only burdens on clinical practice. ICD-10 has increased the number of diagnostic codes from 14,000 to 69,000. It has also added laterality and severity parameters, as well as combination codes to designate complexity. E&M coding and documentation is complex and time-consuming.”
Is there any questions left about why our doctors no longer seem to have the time and/or disposition to carry on extended personal discussions with their patients? While we seem to have made life easier for administrative staff members and healthcare providers to do their jobs, we have put all of the burden of their work on to our doctors. And then we put the blame on our doctors. Perhaps it is time to focus on how to solve this nightmare of electronic medical records as the system exists to take the burden off of our doctors.