Eight medical professionals discuss with Healthline the benefits and drawbacks of having to keep electronic health records.
Does your insurer or hospital group offer a “patient portal” where you can access records, communicate with your doctor, and see your prescriptions and appointments?
Thank electronic health records (EHRs).
EHRs have changed the way doctors note, record, store, and share patient information making them more accessible to patients, fellow doctors, and specialists compared to paper filing procedures.
But the time and effort spent recording information in EHRs may be coming at the cost of physicians’ health, several recent studies suggest.
在一个recent Brown University studyof 4,200 practicing physicians published in the Journal of the American Medical Informatics Association, 91 percent used EHRs. Of them, seven in 10 reported at least one measure of EHR-related stress.
The study also indicated doctors who are not allotted enough time to fill out EHRs were 2.8 times more like to suffer symptoms of burnout compared to those with more accommodating schedules.
此外，2018年survey from The Physicians Foundationfound that nearly eight in 10 doctors experienced symptoms of burnout and that EHRs were one of the top two factors doctors disliked about their jobs.
So, electronic records are good for patients but seemingly a problem for doctors.
To figure out the way forward, Healthline talked to eight medical professionals to get their take on EHRs — and whether they’d ever go back to paper.
Dr. Ken Robinson,facep，南加州Permanente Medical Group
Years practicing:25
Robinson says he spends about 30 percent of his day filling EHRs out and another 20 percent ordering and reviewing results and data.
在保持电子记录的压力上：
“The implementation of the electronic health record (EHR) forever altered the dynamics between patients and physicians. The relationship is no longer a binary doctor-patient relationship but a triangle: a doctor-patient-systems relationship, and the EHR became a third wheel compared to the more elegant, but ineffective, piece of charting paper.”
What can be done to make EHRs better:
“The EHR must evolve beyond a database into a tool that provides only the necessary content, orders, data at the right time. Also, physicians need to be taught the optimal way to use these systems.
“很明显，我们的医生报告了对患者 - 医师关系的负面影响，以及医生的幸福感和喜悦（如这些研究）。
“作为回应,我们一群人——EHR专家医生s, trainers and support staff — were sponsored to create a peer-led educational program.”
On whether they’re a net benefit or drawback:
“The net benefit far outweighs any drawbacks, especially if the physicians using the system are given adequate peer-led training that teaches them how to use the system efficiently and effectively.
“I would never go back to paper.”
Jameca Woody Falconer, PhD, a licensed psychologist in St. Louis, Missouri
Years practicing:17
在保持电子记录的压力上：
“Electronic health records makes my life and my practice much easier. I can access notes and charts and I don’t have to worry about maintaining records because it is all stored online.
“It makes business much easier. It saves the cost of paper and printing and helps to streamline costs of storage.”
On whether they’re a net benefit or drawback:
“绝对是一个净收益。我为EHR支付的费用值得每一分钱。”
加利福尼亚州洛斯加托斯的家庭医生Arun Villivalam博士，MBA MBA
Years practicing:17
Villivalam形容自己是“改革的EHR福音传教士”，他曾经向该国传道，向同伴向同伴讲道：“使用EHR将是最终的答案”。
Now, he’s less sanguine — having used six of the major EHR systems — but still believes in the ultimate benefits of electronic record-keeping.
在保持电子记录的压力上：
“There is stress with both approaches, but overall EHR’s tend to be more stressful for physicians because they require more work than just using paper records. The stress improves with time as EHR familiarity improves.”
What can be done to make EHRs better:
“EHR’s challenges are focused more on extended time with charting (process is cumbersome compared to paper), inappropriate use (overuse) of messaging / communication with staff and providers and between providers / staff and patients, and sporadic unreliability.
“Regardless of paper records or an EHR, the rules regarding documentation and payment likely cause most of the stress in all situations.”
On whether they’re a net benefit or drawback:
“Ultimately, I think EHR’s provide a net benefit because of the more powerful data access.
“I would not be able to travel as I did before and make the same argument that I did before about EHR’s unequivocally, but I would suggest that they do have some major advantages over paper records which have to be shared more widely.”
Dr。Christopher Maiona, chief medical officer at PatientKeeper Inc., Waltham, Massachusetts
Years practicing:20+ years
在保持电子记录的压力上：
“With EHRs, we should have better access to patient information, but it’s often buried in a sea of redundant or irrelevant data, or it may be in an inconsistent format, which makes finding the pertinent information challenging.
“他们总是放慢我的速度，这些年来，他们需要更多的时间。“喂食” EHR本身已成为一项工作。应该成为资产的东西已成为障碍。”
What can be done to make EHRs better:
“想象一下，拥有一个计算机系统，可以通过突出一夜之间的关键过夜更改并帮助以智能方式进行日常任务来帮助简化流程，这与医生的实践相符。这样的突破将使医生更快地在地板上和病人的床边。”
On whether they’re a net benefit or drawback:
“技术不应为医生负担。相反，它应该是一种有价值的资源，可以帮助他们更加清晰，更高效，并且能够更好地与患者互动。”
Dr. Velimir Petkov, board-certified podiatrist in Clifton, New Jersey
Years practicing:10
在保持电子记录的压力上：
“[EHRs] minimizes wait times and practically eliminates man-made errors. My staff also saves valuable time, not having to scan forms and insurance cards/IDs, process payments, etc. They don’t have to call insurance companies to verify benefits as much, as most of them display eligibility directly in our system.”
On his patients’ experience:
“Having no paper forms is great and people love it because most don’t like how long it takes to fill out multiple pages by hand. It’s a lot easier clicking on a device.
“My patients also have an access to a secure online portal (powered through our EHR). It allows them to contact my staff online with any billing questions. But it also gives them a secure way to communicate directly with me — pre- or post-visit.
“They can see all of their information, along with X-rays, lab results, and prescriptions online on their computer or cell phone.”
On whether they’re a net benefit or drawback:
“In my practice, we use Athenahealth for EHR and Yosi for electronic check-in. I personally see tremendous benefits in using both. “
旧金山Carbon Health的联合创始人兼首席医疗官Caesar Djavaherian博士
Years practicing:17
Using legacy platforms such as Epic and Cerner, Djavaherian says he can spend four hours or more on an eight-hour shift filling out records. Newer systems suggest improvement, however.
在保持电子记录的压力上：
“I believe that there is a considerable amount of administrative burden placed on doctors to use new EHR technology that doesn’t contribute to or enhance the experience but instead gets in the way of patient care.
“医生必须花费大量时间点击不同页面，以获取本来可以快速处理的任务。例如，处方…使用EHR需要更长的时间进入。
“Previously, doctors were used to spending a lot of time with patients and documenting their experiences, and now it seems like we’re spending less time interacting with them and more time entering information into EHRs.”
What can be done to make EHRs better:
“With the next generation EHR, I spend 60 to 90 minutes during the course of an eight-hour workday, where I see 25 to 30 patients daily.
“The legacy health records were built on old platforms and never really optimized or enhanced the patient-doctor experience. However, the new EHR enables a better experience for both doctors and patients.
“At the same time, a constraint linked to transmission of EHRs is the interoperability issue -— they aren’t particularly useful for doctors to transfer to another health system.
“At Carbon Health, we use a next generation EHR that allows interoperability, which makes it easy to transfer records to a legacy system.”
On whether they’re a net benefit or drawback:
“ EHR的主要好处是它们提供了患者体验的完整记录，并且可以轻松地将其传输给同一卫生系统中的其他人。
“在EHR的未来方面，我认为有效的途径是实施机器学习模型（我们在碳健康中实施的东西），该模型根据先前对患者的经验提供治疗计划，这些患者表现出类似症状的症状。
“通过实施这些模型，我们可以加快EHR流程，医生可以专注于最重要的事情 - 患者。”
Dr. Mukul Mehra, chief technology officer and co-founder of IllumiCare in Birmingham, Alabama, and a practicing gastroenterologist
Years practicing:14
在保持电子记录的压力上：
“The transaction database has de-humanized medicine and led to physician burnout as screen spaces supercede visual cues, documentation burdens create anxiety, and the element of touch is outweighed by hands on the keyboard.
“我们中的许多人都觉得自己像记录专家，并由注释的长度和编码复杂性而不是解决复杂案例的能力来判断。
“No EHR or AI technology can recreate or assist with the art of the history-taking piece [of medicine]. It can’t even be transcribed because that interaction is real, fluid, interactive, multi-sensed, and the heart of medicine.”
What can be done to make EHRs better:
“为了将医生转为EHR并提高了技术有可能增加的决策能力，我创建了Illumicare和Smart Ribbon。这种EHR不可感染的信息丝带在EHR中做出决定时，为临床医生提供了重要的临床和财政，特定于患者的数据。”
On whether they’re a net benefit or drawback:
“The EHR can be valuable, and we need to make the information clinicians spend so much time entering more actionable.”
罗素·利比（Russell Libby）博士，弗吉尼亚州费尔法克斯（Fairfax）的儿科医生，医师基金会董事会成员
Years practicing:38
在纸质记录上：
“I will give you a perspective on the old way.
“事实是您有耐心的图表，并且有负责将这些图表放在一起的人。您的图表经常且几乎总是混乱的，那里的纸张中的纸是无关紧要的，有时是从其他人的图表中。
“This was not necessarily a great way to do it. You would get called during the day, maybe end up with a note from your nurse and write in answers from the nurse, dump it into a stack, and theoretically, at the end of the day, it would go back into your chart rack.
“The only thing you really hoped is it went back in the right alphabetical order because sometimes patients’ charts were lost forever.
“The notion that we had a better way of doing it was rather misbegotten.”
On EHRs:
“现在，我们有能力，但并没有设计出使人们更好地生活的EHR。
“事实上你必须雇佣一个第三人the room with you — a scribe — because the EHR isn’t capable of using its artificial intelligence to be able to understand where and what and how to translate what your encounter represents into a more meaningful record is crazy.
“因为我认为我们具有技术和能力，但是，需要实施，需要负担得起，并且需要能够代替这些旧系统。”
What can be done to make EHRs better:
“The way we’ve designed [EHRs] is primarily for transaction-based, fee-for-service medicine, whether that be fulfilling certain criteria for recognition of quality, recording certain data that allows you to capture enhanced for maximal revenues.
“It’s not facilitating the actual patient-physician encounter. And it isn’t necessarily giving the value to that visit you could get if you had a better design or more innovative ways to capture data and to categorize it the way that would allow you to fabricate a much better patient-physician encounter.”
On whether they’re a net benefit or drawback:
“I’ll be darned if I think going back to a paper record and having those charts in an office somewhere that really is irrelevant to the moment when you might need it is a step in the right direction. “