After using electronic health records (EHRs) for two years, Joseph R. Schlecht, DO, is of two minds about the technology.
Sure, they’re a big help to ensure accurate prescriptions and claims forms, says the Tulsa, Okla., family physician. But when a nontypist has to type treatment plans on top of having to navigate seemingly endless on-screen forms, the result is a time drain. “It’s frustrating,” says Dr. Schlecht. “It takes an extra hour a day to do my work.”Slow embrace
Market penetration of fully functional EHRs among office-based physicians is only 10.1 percent, according to a recent survey conducted by the federal Centers for Disease Control and Prevention. Reasons often cited for physicians’ slow embrace of the technology include concerns about cost, interoperability, training requirements and potential for practice disruptions.
Dr. Schlecht’s introduction to EHRs occurred in 2008 when his employer, St. Francis Health System, installed an EHR system at its 300-physician clinic in Jenks, Okla. Dr. Schlecht estimates that the clinic’s transition from paper to digital records, which is ongoing, is a multimillion dollar project.
“Our primary reasons for incorporating EHRs are to improve the accuracy of recording patient data, to take advantage of electronic prescribing, and to communicate more efficiently with our peers in the clinic and our referral physicians,” Dr. Schlecht says.
The clinic’s primary care physicians were the first to adopt the software, which was developed by NextGen Healthcare Information Systems Inc. “We probably cut our practices in half for at least six months,” says Dr. Schlecht. “If we had been seeing 30 patients daily, we had to reduce it to 10 or 12 patients a day for the first three to four months. And it was a good six to eight months before we were able to get our patient volume back to where it had been pre-EHR.”
Notepads and pens were replaced by computer screens and keyboards and, in effect, a new method of note-taking. “For all the physicians, there was a steep learning curve during the first few months,” says Dr. Schlecht, who’s been a physician for more than 40 years. “It was a totally different way of doing things. For one, we have to type, which many of us were very poor at doing.”
Old vs. new
Before using EHRs, Dr. Schlecht dictated into a voice recorder. “During patient visits, I would sit down and, reading from a template, dictate the chief complaint, medical decisions, treatment plan and other important information,” he says. “All the time the patient and I were making eye contact and visiting.”
With paper, Dr. Schlecht says he could quickly flip through a patient’s chart to review lab work and referring physicians’ comments. “That system ran very smoothly,” he says. “I could run through a series of lab and diagnostic workups in minutes.”
Today, Dr. Schlecht enters all patient data on computer templates, a process he finds laborious. “For example, when the ‘Chief complaints’ template opens, I go through a list that includes ‘Diabetes,’ ‘Hypertension,’ ‘Hyperlipidemia,’ and more.” Each template is a doorway to yet more templates for recording yet more detailed information. Dr. Schlecht adds that the system does not have a ready-made template for osteopathic manipulative treatment, so he has to type in treatment data.
For Dr. Schlecht, the time required to type and the chore of burrowing through templates are the EHR system’s major drawbacks. “When I have to fill out the lab work template, for example, from the time I click it open until I complete it there are probably 10 separate templates I have to complete,” he says. “Moving from screen to screen is the most frustrating thing with this system. With a paper chart, I quickly flipped through it to get from one part to the next.” Also, because Dr. Schlecht is focused on the computer screen while recording data, eye contact with patients is compromised. And while his daily patient volume has returned to normal, electronic record-keeping has not helped increase office productivity, he says.
What the EHR system has helped, however, is reporting accuracy, Dr. Schlecht says. “One of the features I like very much is e-prescribing,” he says, adding that the automated data entry ensures that every prescription can be easily read. “The pharmacist doesn’t telephone any longer to ask, ‘What are you trying to write?’ Every script is very clear.”
Similarly, Dr. Schlecht acknowledges that the typed notes eliminate any confusion stemming from hard-to-read handwritten comments. This is a plus for other medical staff and, ultimately, for patients.
In addition, the EHR system’s ability to alert physicians to fill in needed patient data, such as chief complaints and physical exam details, helps to ensure insurance claims forms are properly documented.
For example, if Dr. Schlecht misses a physical exam detail, the software stops his progression until he records the needed information. “The most important part is the medical decision-making template, where I have to type the diagnosis and treatment,” says Dr. Schlecht. “I cannot just type the single word hypertension, for instance. That’s not considered a billable service. I have to write out what I did to take care of the patient’s problem.”
Still, he has to withhold rendering a thumbs-up on the technology. He first needs to see added efficiencies, such as doing away with the need to bore through templates. But he is hopeful: “In the long run, I think things will work out,” he says. “If we could get true voice recognition so that I wouldn’t be tied to the computer, that would be a big advance.”