A Prescription for the Achilles Heel of Healthcare IT

Opinion

What keeps doctors from sleeping at night?

Electronic Health Records (EHRs).

More specifically, the “homework” these essential-but-sometimes-inefficient systems generate is enough to cause nightmares.

In a recent study that observed physician behavior, primary care providers spent 40 percent of their patient visit time focused on their computer screens, clicking and scrolling through the patient’s EHR. For those who did manage to focus more attention on their patients, EHR-related work often overflowed beyond the clinic: “I sit down and work usually until midnight,” said an anonymous physician who participated in this research.

While EHRs bring many advantages over paper medical charts, current EHR technologies demand too much of a doctor’s time, navigating nested menus, cutting and pasting text or lab results across functions and windows, responding to an avalanche of alert warnings and searching for specific data from a sea of boilerplate language or difficult-to-use templates. There are even emerging concerns that EHR complexity might have unintended consequences by serving as a new source of medical errors. According to one study, medical errors of all kinds already are estimated to cause more than 1,000 premature deaths a day in the United States.

It doesn’t have to be this way. As we observe National Health Information Technology Week, I can’t help but imagine how EHRs could be more usable and helpful to healthcare.

The idea behind an EHR—providing digital, patient-centered records that make information instantly and securely available to authorized users—is a godsend, and has the potential to … Next Page »

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Zia Agha is executive vice president of clinical research and medical informatics at the Gary and Mary West Health Institute, an independent nonprofit medical research organization focused on reducing healthcare costs. Before joining the institute, Agha was director for health services R&D at the VA San Diego Healthcare System and a professor of medicine at UC San Diego, where he is still a part-time faculty member and practicing physician. Follow @

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  • Good overview of the EHR symptom issue.

    I say symptom, because the IT application known as an EHR system isn’t the problem. The problem is explained by path dependence. Simply put, the EHR system as we know it is the wrong tool for the job. But, it happened. That doesn’t mean we have to live with it forever.

    Instead of EHR systems, what is required is point of care systems that accommodate and integrate all six flows that converge and intersect at the point of care. This inability to accommodate all six flows — which were recently identified as a result of our research — is the real Achilles Heel of the current generation of health IT systems.

    What is needed is a new path, using contemporary IT and networking design leading practices, that will enable us to specify and build the next generation of health IT systems and the rock solid communications infrastructure they will require. Unless — and until — we do that, we have no real chance to achieve the Triple Aim.

    For more insight into a non-commercial, community-based, movement to develop the kind of health IT systems we truly need, I hope you’ll visit http://www.TheCUREProject.org. Check out the Current Research section for more information.

    – Bob Brown