Are EHRs being used to stifle physicians?

Many physicians have been reluctant to embrace electronic health record systems, with concerns about their costs, usability and impact on workflow.

But is physician Adam Sharp, chief medical officer at healthcare start-up par80 and former CMO for online physician network Sermo, correct in stating that the real reason physicians should be leery of EHRs is that the technology is being thrust on physicians to control how doctors practice?

The goal of EHRs is to "wrestle control of healthcare away from the doctor-patient relationship into the hands of third parties who can then implement their policies by simply removing a button or an option in the EMR," he writes in a blog post.  

He also argues that the "ulterior motive" of EHRs ultimately is to hurt patients, who have less opportunity to obtain the "care they want and need." The implication is that EHRs steer physicians to more limited, presumably less expensive treatment options and that if the pricier options were on the EHR drop down list physicians would gravitate toward those.

Interesting idea. But it seems rather a stretch. For one thing, payers surely would prefer that their members receive less expensive treatment alternatives, all things being equal.

But insurance companies aren't designing EHRs; vendors are. Even if arguably the government--as the largest insurer around--has a hand in what critical quality measures it wants in its EHR incentive program, the program doesn't encourage or require vendors, most of whom were designing EHR systems before Stage 1 of Meaningful Use was operational, to remove treatment options from their drop down lists.

And apparently doctors do indeed tend to prescribe more expensive treatments, even when safer, cheaper low-tech treatments are just as effective.

So are EHRs being thrust upon physicians to influence their treatment decisions, and interfere in the patient/physician relationship? Of the almost 80 comments to the blog post, no one even addressed whether EHRs controlled physicians or attempted to manage care. So the blogger's opinion may be more of an outlier.

But what the commenters hotly debated--and what the blog touches upon--is that most EHRs aren't designed with the end user in mind. And there's credence to that opinion.

Case in point: the most recent EHR I viewed was being used in an ob/gyn practice. The drop down list for "reason for visit" included "pelvic pain" and "urinary complaint" but nowhere did it mention "pregnancy" or "suspected/rule out pregnancy." They physician had to type that in.

It's like having to vote for the write-in candidate--you can do it, but it takes more effort.

But that wasn't the only odd item in the EHR. The drop down list for history asks patients if they've been exposed to Diethylstilbestrol (DES) or have AIDs, wbut not the more common about whether or not the patient has ever had a dilation and curettage procedure.

What's more, the e-prescribing function provided the incorrect phone number for the local pharmacy.

It's no wonder that physicians feel disenfranchised. But it's not so much that "third parties" are trying to control the doctors with EHR technology; the systems just need to be designed better. Maybe now is the time for vendors to seek more physician input in designing EHRs. Then not only will the systems work better, but that will give physicians more control. - Marla

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