In 2013, two key studies highlighted an alarming conclusion: The electronic health record or EHR may be hindering the quality of healthcare. One study found that the EHR was the main culprit in doctor “burnout.” The second study found that emergency room physicians click the computer mouse 4,000 times during a 10 hour shift. The EHR and its truckload of computerized quality measures are turning away doctors and nurses from the true essence of their work – Caring for the patient.
Just last week, Mr. Andrew Slavitt, Medicare’s acting administrator, announced the end of a Federal program that tied Medicare payments to a long list of quality measures demanded by users of the EHR. Mr. Slavitt stated, “We have to get the hearts and minds of physicians back. I think we’ve lost them.”
At First Dayton Cancer Care, over $250,000 and hundreds of hours of work have been spent to get the EHR up and running – quite an accomplishment for an independent office. I witnessed how “making the EHR look good” impacts on the time that may be better spent with patients. It has changed our workflow greatly. The clinical staff is required to check a lot of boxes, often on items that are irrelevant to the reason the patient is seeking our help. I still refuse to go into an exam room with a computer. I learn so much about what is truly going on with my patients when I can look them in the eye and watch their body language. These computer prompted questions do not tell the whole story. Fortunately, First Dayton Cancer Care selected a EHR that is specific to radiation oncology. We are able to obtain the necessary information to take excellent care of our patients in addition to everything the government demands of us.
But through all the trials and tribulations of the EHR, I have not seen a single report showing that the EHR is saving lives or improving the quality of care. On a nationwide level, billions of dollars have been spent on the EHR, with little to show for the time and cost. And your medical records are still not all in one place because hospitals and physician group EHRs do not allow secured integration of Personal Health Information (PHI).
While I’m am not advocating that measures of quality can simply be thrown away, I am urging the people in Washington to talk to doctors, nurses and patients, so-called stakeholders in the game, to measure clinical outcomes that truly matter. And in a simple way that does not take away from face to face time with patients. I think we need a revolution in technology so the doctors and nurses do not spend all their time “box checking” on the computer.
In a recent New York Times opinion essay, Dr. Robert Wachter of the University of California San Francisco Department of Medicine quoted a late leading figure in the field of quality management. “In 2000, shortly before Professor Avedis Donabedian died, he was asked about his view of quality. What this hard nose scientist answered is shocking at first then somehow seems obvious. ‘The secret to quality is the love’, he said. “
So for all the time and expense of measuring what the ‘experts’ call clinical outcomes, clinical processes and clinical organizational structure, what it seems to come down to is to CARE. This is the root of why I will not do a patient visit with a computer in my hand. I only hope that “Digital Medicine” does not drive out truly caring doctors and nurses from the field and does not discourage bright young people from entering medicine.
If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at First Dayton Cancer Care at 855-DAYTON1.