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Physicians Vent EHR Frustrations at Town Hall Meeting

AMA bucks the trend

Longstanding physician dissatisfaction with electronic health record (EHR) systems, meaningful use (MU), and the federal regulations behind them were the topics of a town hall-style meeting hosted in Atlanta by the American Medical Association and the Medical Association of Georgia.

The event was part of the AMA’s Break the Red Tape campaign, which aims to postpone the finalization of MU Stage 3 regulations.

While most (80%) physicians use EHRs, the majority of physicians are dissatisfied with their systems, according to the AMA’s Break the Red Tape website. Moreover, physicians are frustrated with the federal government’s MU program, which influences the design of their software and dictates the way physicians must use their EHRs.

In 2009 Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, a bill designed to assist physicians with investing in costly EHRs. Before the passage of HITECH, vendors created EHR software that addressed the needs of physicians and patients. Since HITECH, vendors developed software aimed at meeting the MU regulations, with physician and patient needs coming in second, the AMA says.

According to the association, this is a problem for three reasons:

  • Patient Safety. Physicians are concerned that the quickly designed software systems are contributing to problems with patient safety.
  • Time Constraints. Current MU regulations require physicians to spend a significant amount of time entering data, with more than 100 mouse clicks per patient visit.
  • Financial Burden. Unless a physician complies with 100% of the MU regulations, they will receive a financial penalty.

Rep. Tom Price, MD (R-GA), formerly medical director of the orthopedic clinic at Grady Memorial Hospital in Atlanta, acted as the meeting’s co-host. He kicked things off with a specific complaint of doctors: “Inconsistency is a problem.”

Physicians were quick to identify the barriers to care they say are caused by EHR systems. Over the course of the 90-minute meeting, they raised concerns about reduced productivity, the security of patients’ medical records, interoperability, and government regulation.

On the other hand, Bill Bria, MD, executive vice president of medical informatics and patient safety at the College of Healthcare Information Management, argued that being able to find detailed patient records in a few moments without digging through files, calling the pharmacist to check a prescription history, or attempting to rely on memory is far superior to the alternatives.

“We’re not going back to the paper age,” he said. “That era is over.”

Ann Shepard, RN, vice president and chief informatics officer at Colorado-based Catholic Health Initiatives, agreed with Bria.

“Meaningful use was a significant driver for us and our EHR adoption,” she said. “Before the HITEC Act, we were using a combination of paper files and just minimal electronic records, but legislation pushed us a little faster than we were going.”

Pointing to the bar-coded medication administration (BCMA) system, Shepard said that certain innovations nurses now rely on would not be possible without EHRs. “It’s allowed for enhanced patient safety. When a busy nurse goes to the medicine cabinet, she’s usually trying to remember what she’s already given out, the dose, the route, what she still has to give out that day — and there are opportunities for error in those situations.”

With BCMA, nurses have the ability to build in safety checks. A barcode on the patient’s bracelet helps keep track of which medications are due to the patient at what time, and the right dose, while the nurse is double-checking that this is the correct patient.

“These and other innovations that utilize EHR systems decrease errors that cause harm to patients,” Shepard said.

While the physicians attending the town hall meeting made their dissatisfaction clear, Bria said that it’s too late to reverse the EHR trend — and high time physicians embraced it. “It’s just a cost of doing business,” he said.

Sources: HealthLeaders Media; July 21, 2015; and AMA; 2015.


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