Commentary expresses “building resentment against the shackles” of electronic health records

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Photo by Daniel Sone

Current electronic health records, also known as EHRs, have many failings. That’s according to a commentary written by Stanford faculty members Donna Zulman, MD; Abraham Verghese, MD; and Nigam Shah, MBBS, PhD, that appears today in JAMA.

Zulman, assistant professor of medicine, elaborated in a recent email:

“Many physicians are frustrated with the dominant role of EHRs in today’s clinical practice, which is experienced physically in the exam room in the form of a computer that sits between the doctor and patient.

While EHRs facilitate certain tasks, such as medication orders and medical record review, they’ve shifted clinical care away from the profound interactions and relationships that motivate many physicians to pursue careers in medicine. Our objective in this essay was to describe the need for EHRs to evolve in a way that frees physicians to focus on the caring that only they, as humans, are equipped to provide.”

According to the commentary, specific failings of EHRs include: lengthy records that don’t prioritize meaningful information, the generation of too many non-urgent alerts that continually interrupt physician workflow and the absence of key information about patients’ environmental and behavioral stressors. EHRs are basically “designed for billing” rather than easy use by healthcare providers, they write.

Zulman added:

“Many record systems house data for large populations that could potentially inform treatment decisions for individual patients. By synthesizing information about other patients with similar demographic and clinical characteristics, EHRs could provide recommendations to help guide therapy decisions when traditional evidence is lacking. Expanding the types of information in EHRs to include social and behavioral determinants of health would greatly enrich the data available for these purposes, since we know that these factors are often fundamental to a patient’s treatment response and health outcomes.”

The authors also describe ways to improve how information is presented in EHRs, particularly when a patient has a complex medical history. For instance, they suggest capturing the key events of a prolonged illness in a single graph, so physicians and patients can easily visualize the clinical course of the disease and treatment. Overall, they argue that existing technology can be used to more effectively track, synthesize and visualize EHR information.

The authors concluded in their piece:

“There is building resentment against the shackles of the present EHR; every additional click inflicts a nick on physicians’ morale.

Current records miss opportunities to harness available data and predictive analytics to individualize treatment. Meanwhile, sophisticated advances in technology are going untapped. Better medical record systems are needed that are dissociated from billing, intuitive and helpful, and allow physicians to be fully present with their patients.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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