Going digital: Encouraging physicians to adopt EHRs

If you’ve been to a physician lately, you have probably noticed that tablets and laptops are starting to replace the old clipboards in recording your answers to which medications you take, what allergies you have and all of the other information needed to treat you properly. These electronic health records (EHR), as this data is called when it is put into specialized software, are the subject of a major governmental push, but implementing the digital system is not without its challenges.

The theory behind EHR is simple: to easily share information between doctors, hospitals and insurers so that the patient receives both the best and the most cost-effective care. “Medicine is more complex than it used to be,” said Nancy Dickey, MD, president emeritus of the Texas A&M Health Science Center and executive director of the College of Medicine’s Rural and Community Health Institute (RCHI). “Electronic health records make it much easier to share information between a primary care physician and one or more specialists involved in a patient’s care.” This helps eliminate redundancies by making results from diagnostic procedures conducted by other providers accessible to all those treating a patient. Complete medication lists, which can be created when prescriptions written by all physicians are in the system, reduce the chance of duplicate therapy, drug interactions and medication abuse. EHR might also be useful in an emergency if the treating physicians are able to easily access information about the patient’s allergies and preexisting conditions.

The initiative is not without controversy, though. It can be overwhelming to try to transfer years of paper records into an electronic system. The investment in hardware, software and training of the necessary medical personnel is considerable. Once purchased, the software might be difficult to use. Some people—both patients and physicians—worry about patient privacy. Some medical practices have hired scribes to enter the information into the electronic system during the patient’s appointment, and experts worry that the additional cost of this extra staff member will be passed along to patients.

Texas A&M’s RCHI, a health extension center that serves as a bridge for health care professionals and their organizations with academic centers, policy makers and researchers, has tried to ease the transition. Utilizing a $10 million grant from the federal government that was part of the $30 billion HITECH Act of 2009, the RCHI has helped more than 2000 physicians in East/Central Texas implement EHR. Now that the grant is over, they are offering this as a fee-based service.

Many are taking advantage of the program, as the federal government requires that health providers “meaningfully use” EHR in order to be reimbursed under Medicare, and penalties not meeting that level of use begin in January 2016.

Some worry, though, that something is lost in the “checking of boxes” that EHR encourages, rather than the writing up of detailed reports of patient visits as physicians tended to do in the past. “EHR is often a Spartan approach,” Dickey said, “and medicine is very rich.” This might lead to different safety concerns—not more concerns, she emphasized—just different ones. EHR prompts the physician to think about what they’re doing before they prescribe a medication that reacts badly with other medications the patient is taking and warns them if they try to prescribe something to which the patient has an allergy. It may also prompt a physician to remind their patient that a preventative health screening or vaccination is due. On the other hand, it is easy to check the wrong box and therefore miss noting something of importance.

“I suspect we’ll spend the next 15 years trying to put some robustness back into the record keeping,” Dickey said, “and identifying the most problematic errors that occur and fixing them.”

The next generation of physicians might be the ones to use EHR to its full potential. The Texas A&M College of Medicine is teaching its students how to use EHR, and this generation is much more comfortable with technology than generations of physicians before. The college is also working with Dell to create a health technology academy to provide customized information technology education to both current students and, as part of a continuing education program, practitioners already in the workforce.

“We warn our students that they are entering a life that demands continuous learning—and—unlearning, as the science of medicine continually changes.”

“While information technology is a different kind of science, its emergence is going to impact providers in many ways, from selecting personalized treatments based on genetic predispositions to extending the capacity of physicians to collaborate across the globe on complex cases. Learning to move our data from 4×6 cards and paper charts to electronic formats is just the first step, but one that every provider will embrace in the near future. As with Texas A&M’s long history as a land grant institution, the College of Medicine and RCHI intend to be out there assisting today’s learner as well as those who are busily caring for Texans to make the changes as efficient and effortless as possible,” Dickey said.