The general consensus surrounding the movement to EHRs, at least from what I’ve heard and read, is that, although not perfect, EHRs are a good thing for doctors, healthcare organizations and patients alike. Where the problems come in are with the other stuff. For example, the lack of interoperability bars EHRs from reaching their full potential. The story of Janet Freeman-Daily, a lung cancer patient who keeps all her medical records in a 3-foot-deep file drawer and brings copies to her various appointments to keep her caregivers up to date, illustrates this roadblock.
But some in the medical community think EHRs are transforming healthcare in a way that severely detracts from the patient. In fact, for some physicians, EHRs are the reason why being a doctor today isn’t about patient care anymore. At least, that’s what Pulitzer Prize winning columnist Charles Krauthammer, M.D., expressed in a recent Washington Post opinion piece. Because of EHRs, he wrote, being a doctor is now about data entry. He also argued that EHRs are not more efficient, effective or beneficial to the patient than how things were done before like so many believe them to be.
EHRs detract from patient care because doctors spend more time dealing with data than directly with the patient, Krauthammer wrote. He cited a study by the American Journal of Emergency Medicine that found that ER doctors spend 43% of their time entering information into a patient’s EHR and only spend 28% of their time with patients. He also cited a JAMA Internal Medicine study that found that physicians spend on average 48 minutes a day just entering clinical data.
“Forget the numbers,” Krauthammer wrote. “Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.”
Although I can see where Krauthammer is coming from, and the numbers are pretty damning, I’ve personally never had this experience with my own doctor. Maybe she’s one-of-a-kind but when I see her for my annual check-up she spends about the first five to 10 minutes asking me if there’s anything new she needs to know and updating my medical record. Then she spends the rest of the approximately 30 to 40 minute appointment engaging me, talking to me, asking me questions, and listening to any concerns I have. Truthfully, I feel like my doctor genuinely cares about me, advocates for my health and encourages me to advocate for my own well-being as well. I’ve never felt ignored by her or that I’m taking up too much of her time.
But Krauthammer is not alone in how he feels about EHRs. In a letter to the editor of SearchHealthIT, Alan Ducatman, M.S., M.D., professor of medicine and public health at West Virginia University, expressed the same concerns.
However, you can’t simply shrug off electronic records. EHRs offer many benefits, including:
- Improved quality and accuracy of patient care.
- The ability to better utilize e-prescribing.
- Reduced costs by helping to eliminate unnecessary medical testing, dictation services, paper copies of medical records, etc.
- Financial incentives from the government (although many debate whether these incentives are worth the hassle).
- Improved information accessibility.
- The ability to send bills more quickly.
- The ability to sort patient data and look at specific demographics.
- Saving trees.
Regardless, Krauthammer said the reason doctors are seriously considering quitting their jobs—he asserted that virtually every doctor and doctor’s group he’s talked to says the same thing—is because EHRs make medicine more about the data than the patient.
“Clicking boxes on an endless electronic form turns the patient into a data machine and cancels out the subtlety of a doctor’s unique feel and judgment,” Krauthammer wrote.