We Need A Better EHR

Electronic health records are all the rage. As a nurse, they make documenting easier, faster, safer and more reliable....but do they really?  According to the Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs (2015) many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, new and burdensome data entry tasks being transferred to front-line clinicians, and lengthened clinician workdays. Additionally, interoperability between different EHR systems has languished despite large efforts towards that goal. These challenges are contributing to physicians’ decreased satisfaction with their work lives.

How do we fix these inconsistencies? How do we make a system that is supposed to make our lives easier better? There is a plan to make the EHR better for those that use it most, the health care worker. Monegain (2015) breaks down several steps developed by an IT task force that will take the EHR into the next century. This is a breakdown of the ways in which the EHR can be streamlined and improved.

            First, the process of documentation needs to be streamlined and simplified. In many cases it seems that members of every discipline enter the same information over and over again. There is repetition that takes each person valuable time. This ends up being time that could be better spent with the patient. Most of the documentation comes down to the physician being the main responsible party but other members of the care team should share in the documentation and should be just as valued as the physician. Even the patient could input some of the data themselves, especially regarding their own history.

Documentation is not just about writing notes like it used to be in the past. The EHR required us to input encoded data that often causes issues based on the fact that there is no standardization.  Unfortunately the EHR does not have a standardized interface, so this often causes glitches in the system and problems as codes are not recognized. There really needs to be standardization of this process.

The EHR is looked upon as being such a miracle system that there are not a whole lot of resources set aside for research and improvement. According to Monegain (2015) we need similar studies to understand the cost and benefits of proposed data items to be recorded in the EHR. We need researchers looking at the EHR long term and continually finding areas where improvements can be made.

The restriction of informatics research is being caused by commercial monopoly. The EHR has been hijacked by commercial companies that are edging out the smaller competition. This is making the EHR suffer because the research is not being done in order to look at safer, more efficient and perhaps more cost efficient options. Big business is truly stifling the innovation in this area. We need to prevent this type of monopoly from happening so we can continue to expand and improve.

            The EHR is an amazing system but it is not without its problems. The very thing we found to make out job easier is creating other problems that need solving. It is only with continual research and innovation that we can solve some of the problems the EHR has created. This way we can get back to what matters most, the patient.

References

Monegain, B. (2015). What will EHR’s look like in 2020?. HealthcareITNews, 
                Retrieved from http://www.healthcareitnews.com/news/what-will-ehrs-look-
                2020

Payne, T., Corley, S., Cullen, T., Ghandi, T., Harrington, L., Kuperman, G., 
                Zaroukian, M. (2015).Report of the AMIA EHR-2020 task force on the status 
                and future direction of EHRs. Journal of the American Medical Informatics 
                Association. 22(5), 1102-1110.