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Fighting rising workloads: How EHR use can complicate patient visits

EHR use is convenient but complex, and often uncompensated. And such federal grant programs as the Beacon communities don't directly affect physicians in the field.

The federal government hopes its grant programs to establish health information exchanges (HIE), boost adoption of health IT and cultivate quality improvement will lead providers to implement and use electronic health record (EHR) systems more quickly. Those grant programs have less impact on physicians already engaged in EHR use in the field, however -- and they say that disconnect needs to be addressed.

The U.S. Department of Health & Human Services' (HHS) latest grant created 15 Beacon communities to help demonstrate the adoption and meaningful use of health IT to improve quality of care in regions across the country. With the communities in place, HHS now has significant grants established across three programs aimed at creating health information exchanges, helping physicians understand their IT needs through regional extension centers (REC) and furthering the use of that technology in meaningful ways.

While the Beacon organizations are confident their programs will be effective in collaboration with the other two, one doctor already experienced with EHR use says workflow management, not more technology, is the biggest issue.

It is a double-edged sword, but there is no looking back.

Lisa Starobin, internist, Harvard University Health Services

Technology -- from emails to secure electronic messaging -- has made communicating with patients more convenient, according to Lisa Starobin, a physician at the Boston-area Harvard University Health Services who has been using electronic records for the last decade. But that convenience has its own price: Physicians spend several more hours on their patients' care than the time that office visits take, although only clinical visits are billed. "There's a lot of work that goes on outside of patient visits," she said. "It's really uncompensated work."

Even patient visits themselves have become more complex as a result of EHR use. Doctors are entering data and trying to ensure that the whole medical chart, not just the specific medical visit, is aligned, so they can track diseases and monitor their patients' overall status, Starobin said.

"[I'm] clicking on a lot of stuff," Starobin said. "When you do it 20 times a day, it adds up."

The federal government could probably have the biggest impact in the area of health information exchange, Starobin said. It's easy to maintain patient data internally, but when physicians try to align a medical record after a patient visits another specialist or clinic that doesn't use electronic systems, they are back to using paper and faxed documents, she added.

"It is a double-edged sword, but there is no looking back," she said. "I can see why a lot of doctors aren't psyched about EHRs."

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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