Invite doctors to the decision-making table

I received a number of comments and other feedback agreeing with last week's commentary that EHR satisfaction reports, particularly from the government, should be taken with a grain of salt. (And thank you for your kind words.)  

But while skepticism is healthy, certainly there is some truth to the figures. There are plenty of physicians who are pleased with their EHR systems and taking full advantage of their capabilities.

So I was somewhat surprised at the very negative reaction from one physician I spoke with this week about whether he, with his significant Medicare patient base, was considering adopting EHRs.  He was quite conversant about EHRs, as I presume are most physicians these days. But he has no desire to use one, noting that they were too expensive, less secure, adversely affected patient care and created more work than paper records.

"The government seems to think that EHRs are better, but they're only looking at economics," he explained.  "No doctors are making the decisions about EHRs."

Now, I don't agree with everything he said. EHRs can improve patient care and workflows. And there are many other benefits to EHRs, such as data sharing and patient engagement.

But this physician--whom I have known for years--raises an interesting point: Are physicians sitting at the grown-ups' table? Are they part of the decision-making process in terms of EHR design, implementation and innovation? Have they been given the opportunity to weigh in?

And are the decision-makers listening?

Organizations such as the American Medical Association and the Medical Group Management Association do an admirable job of providing input when given the opportunity. But if the actual end users--the individual physicians--feel this disenfranchised, that's a big problem.

There are occasions where physicians can weigh in on EHRs. For example, just this past week the Agency for Healthcare Research Quality (AHRQ), in its recent request for information about using EHRs to measure quality, specifically asked clinicians to submit comments. Farzad Mostashari, the National Coordinator for Health IT for ONC is a physician. And there are physicians who are members of ONC's Health IT Policy and Health Standards Committees.

But how many physicians enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act, which created the meaningful use incentive program? How many physicians were consulted?

Of the hundreds of EHR systems out there, how many physicians are integrally involved in their design? How many vendors hire or consult with physicians?

Part of the problem is lack of transparency. Clearly there's a perception that physicians are not part of the decision-making process. It may be occurring, but we're not seeing it. It may behoove vendors, agencies, and others who make decisions regarding the design, adoption and implementation of EHRs to publicize their utilization of physicians in performing their work.

But at the same time, there is a reality that some of these programs and design features are less than optimal for the end-user. So it may be worthwhile to revisit how often and how well physicians' voices are heard regarding EHRs and enable them to make more of a contribution.

Let's make sure that physicians are invited to the table.  - Marla