Surprise! EHR’s are hurting not helping the doctor /patient relationship.

Summary: A healthy Patient-Doctor relationship is the core of all healthcare.  This reports on a JAMA* study as well as one brilliant doctors’ personal view on the impact of EHR’s on that hallowed relationship.

When JAMA publishes a study, everyone pays attention. But this was not a clinical study; this was research into the impact of EHR’s (Electronic Health Records) on the patient-doctor relationship. They videotaped numerous consults and them interviewed the patient afterward.

Guess what, the news is not good. (Especially for those Biopharma marketers looking at EHR’s as a new promotion channel: do you really want to annoy the doctor more by interrupting their work with a savings card?)

With the healthcare system was heading towards the abyss of being too costly, the Affordable Care Act was supposed to be the game-changer for nearly every aspect of the entire trillion dollar industry.  One mandate was for all patient records to become digital (and accessible). Incentives and punishments were created requiring doctors and hospitals to have Electronic Health Records as a means to more efficiently serve patient care, lower costs  and create Connected Health with inter-operable systems…a glorious vision of a healthcare system that is efficient and patient-centric.

Well, maybe not so patient-centric as the architects of the ACA believed. The collapse of the independent practice, the turnover of EHR’s, the bad User Experience, are all well known shortcomings.

JAMA looked at the reality of what “efficiency” really means to patient-centricity:

  • The researchers used data from encounters between 47 patients and 39 doctors at a public hospital between 2011 and 2013.
  • Doctors who entered data into computerized health records during patients’ appointments did less positive communicating, and patients rated their care excellent less often, in a recent study.
  • Doctors who used the computer more also spent more time correcting or disagreeing with patients.
  • Private practices, due to ACA, EHR and other burdens, have collapsed and been acquired in droves by large hospital networks (estimated under 30% remain private); in doing so, doctor’s are in the thrall of hospital guidelines and procedures…and no real influence on choice of EHR’s!

No wonder patients are unhappy! So are doctors! Doctors are trained to observe a patient, literally watch them closely as they speak and use their experience and observations to help in every part of their patient care. But EHR’s force them to break their training habits– type in their laptop, look up-and-down, asking the usual questions and perhaps miss the visual cues they were trained to catch.

The famous ZDoggMD  created a YouTube video just asking: “Let doctors be doctors!”  This is a witty and worthy  commentary from a doctor who is trying to bring a doctor-centric view of fixing medicine. PLEASE watch his video.

Clearly, the ACA/EHR boulder is rolling downhill at it’s own speed and regulatory-demands. Perhaps once all EHR’s are voice-activated (my ENT has one but I wonder if it catches his off-color jokes), and UX is more point-of-care centric, this mess will turn a more positive corner.

*SOURCE: JAMA Internal Medicine, online November 30, 2015