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EHR time drain: Oklahoma DO bemoans tunneling through software templates

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Joseph R. Schlecht, DO, lauds his electronic health record system’s accuracy but finds the new workflow cuts into efficiency. (Photo courtesy of Dr. Schlecht)

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.”

This is the second article in The DO’s series “EHR Experience,” which examines the experiences of osteopathic physicians who have adopted electronic health records. The first article looked at a solo family physician who built her practice on EHRs from the beginning.

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.

AOA and AOAMI resources

Meaningful-use guides: On Osteopathic.org, the AOA features several briefs on helping DOs make “meaningful use” of health information technology.

News and tools: The website of the American Osteopathic Association of Medical Informatics features news, tip sheets and other resources on health care information technology.

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.”

dmccann@osteopathic.org

10 Responses

  1. Tweets that mention The DO | EHR time drain: Oklahoma DO bemoans tunneling through software templates -- Topsy.com on Feb. 22, 2011, 4:31 p.m.

    [...] This post was mentioned on Twitter by TheDOmagazine, OSU Rural Health. OSU Rural Health said: RT @TheDOmagazine: EHR time drain: Oklahoma DO bemoans tunneling through software templates: "It's frustrating." http://bit.ly/fq04qN [...]

  2. SOMA-DO-MBA on March 4, 2011, 3:10 p.m.

    Sorry that technology is cramping your style. Happy medium: Use your dictating device as you used to and either hire/have an assistant pre-input the information or input it yourself later. Still makes for a longer day and a higher resource drain, but you don’t have to go from 40 patients to 12, even during the learning phase.

  3. Terence Grewe, DO on March 4, 2011, 3:11 p.m.

    I’ve been using EMR for almost 7 years. I couldn’t live without it now. We never lose a chart and I can access patient files anytime. I find it much faster than paper or dictating.

  4. Sunnyt on March 4, 2011, 5:40 p.m.

    My husband is a FP and I teach technology. Would the physician consider taking a typing class? There are many programs that he could use on his home computer to help him learn to type correctly, making one less barrier to his EHR use. The problem of tunneling through so many templates appears to be a problem with the EHR program his employer has chosen to use.

  5. D. Haas, D.O. on March 4, 2011, 5:48 p.m.

    EMR’s definitely have their good and bad points. As Dr. Grewe pointed out, the access to patient information is invaluable and saves alot of time looking, calling and faxing. I can e-prescribe anywhere and don’t have to write notes to stick in my pocket when called outside the office. I get warnings on drug interactions and allergies and even when rushed the risk of making a mistake is nearly taken completely away. I am able to access office records in the hospital and veiw other provider’s input on the hospital system. On the downside, the input of data using electronic templates is a little more time consuming and it is hard to find a system suitable to your style. I find templates annoying and can bypass some of that “drop down menu template input” by using Dragon Naturally Speaking – an invaluable time and money saver. EMR’s are not the panacea they are sometimes made out to be, but are definitely a step towards better management of our patients.

  6. Rick on March 4, 2011, 8:25 p.m.

    After 30 years of paper charts I started EMR in Jan of this year. A struggle at times it gets better each day. I however do take it home and review my patients seen every night to make sure all the documentation is done. Seeing a few less in a day butI think it will be worth it. On the weekends if I get a call I can pull up the chart and not have to rely on memory.

  7. Rick on March 4, 2011, 8:26 p.m.

    Additionaly it will be better when all the different programs will interface with out having to scan so much

  8. wwc on March 7, 2011, 11:58 a.m.

    Consider using a scribe in your practice. Our experience shows that this can be helpful to you in your documentation and allow you to see more patients daily. In some cases it will even help you in paient satisfaction. I doubt that EMR is going away anytime soon especially when ACO’s are enacted.

  9. C Quincy, DO on March 7, 2011, 9:57 p.m.

    IMO EHRs are not ready, yet. I used one first in 1980 in Vermont with Dr Larry Weed. A beautiful ahead of it time touch screen hospital demo project. The problems then are like now: slow tedious templates, physicians who don’t type, time consuming data collection…. In 30 years, and I’ve followed the technology, the EHR doesn’t work, unless you have an in-house IT department. If the payoff is improved patient care, I haven’t seen a good prospective, placebo controlled trial. The idea is laudable but the unintended side-effects of increased institutionalization, increased insurance intrusion, audit and control, and the inapplicability to high touch practices makes me very reluctant to be herded into this. If total digital capture of medical events is really necesary, we might just install cameras in every exam room.

  10. The DO | Slow Internet connection dead-ends Web-based EHR for rural DOs on May 17, 2011, 2:17 p.m.

    [...] The second article examined a DO‘s frustrations with charting in his new EHR system. [...]

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