Doctors Want EHR 2.0

An long-running complaint about software development is it is rarely done for consumers -- the users of a program. Software is typically written for some other agenda or use. That's when you hear the complaint that a program isn't intuitive and is hard to navigate. (Although an exception is Apple's iPad, which has routinely received positive reviews about its ease of use.)

Complaints about a program now come from doctors who say the interface of electronic health records just doesn't work the way they think and organize patient data. That's one of the points Drs. Gordon Schiff and David Bates, of Brigham and Women's Hospital and the Harvard School of Public Health in Boston, made in a recent article published in The New England Journal of Medicine.

Although clinical documentation plays a central role in EHRs and occupies a substantial proportion of physicians' time, documentation practices have largely been dictated by billing and legal requirements. Yet the primary role of documentation should be to clearly describe and communicate what is going on with the patient.

That's right. The billing and legal departments have dictated how patient records have been designed. Should we be surprised?

Make no mistake, however, Schiff and Bates are big EHR supporters, a view they acknowledge runs counter to the opinions of some of their colleagues who argue that "electronic documentation in its current incarnation is time-consuming and can degrade diagnostic thinking -- by distracting physicians from the patient, discouraging independent data gathering and assessment, and perpetuating errors." (Link added.)

But the two authors have a solution. They call for system developers and government agencies overseeing the development of EHR standards to push for the next generation of electronic records to be more user-friendly for physicians and work the way doctors work and think. Sound familiar?

Systems developers and clinicians will need to reconceptualize documentation workflow as part of the next generation of EHRs, and policymakers will need to lead by adopting a more rational approach than the current one, in which billing codes dictate evaluation and management and providers are forced to focus on ticking boxes rather than on thoughtfully documenting their clinical thinking.

Schiff and Bates offer six ways to improve EHRs, but for anyone who has been involved in the process of developing a system or application, it's going to take a lot of communication between clinicians and EHR vendors to nail it. Vendors may get it right by version 4.0.