Docs equate EHRs to 'shackles,' say they hurt morale


Physicians are dependent on electronic health records for diagnosing, monitoring and treating patients, but the systems are rife with shortcomings, particularly in the increasingly complex world of medicine, according to a new viewpoint article in the Journal of the American Medical Association (JAMA).

The article, written by doctors from the Stanford University School of Medicine and VA Palo Alto Health Care System in Menlo Park, California, note that while EHRs have benefits, such as clinical decision support, they have not kept up with technology used to track, synthesize and visualize information in other areas of modern life. For instance, they say, while EHRs and algorithms using EHR data can identify patients at risk for certain conditions, most systems don’t integrate that information in a way that supports tailored treatment decisions based on the individual patient. EHRs also don’t include social and behavioral factors needed for a patient’s treatment response and health outcomes, the authors write, such as unique stressors at home.

As a result, doctors are “building resentment” against the “shackles” of EHRs; the authors add that “every additional click inflicts a nick on physicians’ morale.”

Their recommendations to improve EHRs include:

  • Better triage of alerts and fewer workload interruptions
  • More thoughtful and valuable ways of depicting information, such as enhanced graphic representations
  • Adding social determinants of health
  • More intuitive systems that allow doctors to be “fully present” with their patients

“At present, the spectacular effects of computers in science and in the secular world are not reflected in the EHR, which for physicians remains burdensome, all-consuming and far from intuitive; this is not surprising, when the dominant EHRs are designed for billing and not primarily for ease of use by those who provide care," the authors warn. "Many phenotypic observations (the outline of a cigarette packet in a shirt pocket, or spotting neurofibroma, fasciculation, or rash) change the diagnostic algorithm and are easy to miss when work revolves around the computer and not the patient."

To learn more:
- read the viewpoint article in JAMA