Physicians and EMRs: A Tipping Point?

A few months ago, I had a routine visit with my longtime OB/GYN. The exam room was newly outfitted with a computer suspended from the wall. The visit followed a familiar pattern with the usual friendly exchanges, with one exception: Periodically, my doctor tapped visit notes into the computer.

I asked how she liked the new electronic medical record (EMR). My doctor was enthusiastic about the possibilities, despite how different it all was from when she started practice 25 years ago. But then she offered that one of her longtime partners had chosen to retire rather than learn the system.

The rapid implementation of EMRs is being driven in part by the federal government’s “meaningful use” financial incentives. As a result, we’re living through a “storming and norming” period, as physicians face dramatic change in how they access patient information. A particular slice of physicians nearing retirement age see this as a good time to leave practice; however, many of their contemporaries are also logging on and skilling up.

Every year I read thousands of physician survey comments about what they think needs to be improved in their hospitals and clinics. In the last three years, computerized physician order entry and EMRs have been a hot topic. Some of the most blistering comments I’ve read have ripped EMRs as endangering patient safety, missing critical information and being highly inefficient. Typical frustrations have been:

• Lack of access to labs, imaging, nurses’ notes and outpatient information.
• No patient flow sheets so what’s happened to the patient since admission isn’t apparent.
• Computers that are too few and too slow.
• Medication lists that jumble together past and current drugs.
• Lack of timely IT support.
• Inadequate customization for specialty needs.
• EMRs that are cumbersome and add hours to already long workdays.

I’ve seen medical staffs in full rebellion, demanding that an EMR with a huge price tag be dumped because of these issues. But things are starting to change out there. I see it in the comments and scores on IT and EMR questions on physician satisfaction surveys.

One key driver for physicians of all ages has been the desire for more personal time. Remote access to lab, imaging or the full record may mean that the doctor can avoid a trip to the hospital. Seamless remote access is not only a time saver for physicians, it enhances patient safety. Doctors see this and want this.

There’s still great variability in how well EMR implementations are going. Here are some best practices I see in smart hospitals and clinics that are engaging with their physicians and therefore experiencing smoother electronic record implementations:

• Highly visible physician leaders who prepare the medical staff and constantly dialogue with doctors to identify issues and share ideas.
• Great advance planning with involvement of both physicians and nurses from early on. IT professionals who design or implement EMRs without this input are usually heading their institutions for problems and resistance.
• A commitment from the EMR vendor for rapid response to valid physician concerns. No doctor is going to be satisfied with a minor fix that takes a year to implement. A major academic medical center that I work with defused faculty anger over functionality issues by providing monthly updates on EMR improvements.
• Creation of highly responsive support when a doctor at a computer needs help, especially at the time of implementation. Sometimes this support is a dedicated physician IT SWAT team ready to respond on a moment’s notice. I’ve also seen effective use of hospitalists as super users as they are likely to know the EMR well and are often willing to help physician colleagues get up the learning curve.
• Making systems highly efficient, integrated and physician-friendly. Multiple log-ins, unnecessary layers of screens and too few computers on the floors are killers. Separate systems for lab, radiology, the emergency department and physician offices are a major barrier. Integrating these as rapidly as possible addresses both efficiency and safety concerns.

Commentators about physician resistance to electronic records have typically painted doctors as technophobes instead of acknowledging their legitimate concerns. But isn’t it in patients’ best interests that their caregivers have rapid access to all key information for their care?

In the past year, I’ve read far fewer comments about EMR failings. I suspect it’s due to multiple evolutions: vendors doing a better job of providing more functional, efficient products; more integration of previously separate systems; and a critical mass of physicians who’ve become proficient users and advocates.

These days I hear more physicians asking for EMRs to be deployed more rapidly at their hospital and office. I even see electronic records appearing as a “greatest strength” of a hospital or clinic rather than an obstacle to good care.

In short, there are signs that we’re reaching a tipping point among physicians in the acceptance of well-designed electronic medical records as part of accepted, even improved practice.