I had to chuckle when I read “EHRs are the problem, not the
solution” (Healthcare IT News, March 2006).  Yes, Mr. Steele, the EHR is simply a basic undoing of the way physicians customarily practice. Thank goodness!

    Physicians are locked in an archaic paper-based system that increases costs, facilitates duplication of effort and medical procedures, enables the medical profession to function as a guild, and increases the risks for errors.  Yes, the EHR can change the customary way physicians practice.

    The major reason for slow adoption to EHR by physicians is resistance to change.  Another real reason is the fact that many EHRs do reduce efficiency and productivity by imposing typing skills (many physicians cannot type and are intimidated by a keyboard), by not supporting physician workflow, and by not supporting physicians’ specialty-specific needs.  Well-designed EHRs can improve efficiency through work-flow support and clinical content that makes the documentation process easy.

    Well-designed EHRs shift some of the work from the physician and staff to the patient.  For example, when a woman schedules a new prenatal appointment, the medical and social history is taken from the patient in a dialogue format.  This involves the work of at least two people—the patient and a clinical person.  Moreover, the responses to questions of the patient may be biased by non-verbal communication on the part of the person recording the history. This process can be reduced or eliminated by crafting on-line patient questionnaires that enable the patient to enter history prior to the appointment in a relaxed setting, with maximal information available, and with no value judgment given a question (“You’ve never had a sexually transmitted disease, have you?”  The interviewer shaking the head—NO.).  The physician can then focus on relevant information rather than having to gather information.

Well-designed EHRs enable physicians and clinical staff to order laboratory studies, procedures, and medications that are appropriate to the diagnosis.  Orders are legible and deviations from standards of practice can be triggered as alerts and reminders.

One of the unexpected, beneficial consequences of EHRs is patient acceptance and satisfaction.  EHRs that provide a patient portal empower patients to have greater knowledge about their personal health and to participate as a partner with their health care provider.  

Document management solutions, proposed by Mr. Steele, may provide comfort to physicians, but can do none of the things described above. Document scanning is a component of well-designed EHRs to preserve old records and current information that comes in paper form.  However, document scanning is not a solution for the future. Mr. Steele advocates the status quo of comfort with continuing use of paper.  Just as the DVD has replaced VHS tape and the computer has replaced the typewriter, the EHR will replace the paper record and its derivatives.  Paper is the problem, not the solution. Physicians need a basic undoing of customary practice that buries them in mountains of paper.  Let’s provide electronic solutions that ease the undoing and lead physicians to safer, better practice methods.

G. William Bates, M.D., MBA
Chief Executive Officer, digiChart, Inc.
Nashville, Tennessee