Your Doctor Hates the Electronic Health Record. I Love it.

ehrWe have all had the experience. We go to our doctor for an annual physical, or to work out some specific problem, and they spend most of the time reading their laptop or typing data into it. Personal contact and face-to-face time feel smothered by the need to enter all your information to be stored in some vast cloud. Is it worth it?

Electronic Health Records (EHR) have been around for quite a while now. They started out in hospital settings but moved into doctors offices in force a few years ago when the Federal Government partially subsidized their purchase and Medicare began instituting payment policies that virtually required physicians to use them in order to receive "maximum" reimbursement. All while collecting lots and lots of data.

The drawback, and one of the reasons physicians hate them is that they are massive time sucks. "Maximizing" reimbursement is a losing proposition if maximizing patients 1 through 5 means that you can't schedule patients 6 through 8. Some practices hire "scribes" to enter data in the EHR while the physician examines the patient. That works for some.

These systems are also notoriously balky and require hard-working IT teams to keep them at a functional level. And heaven (or Medicare) forbid a change in regulations. Updates can wipe out a system for days, grinding information transfer to a halt.

So whether they go by the name of Epic, or Allscripts, or any of dozens of others, most clinical offices hate these things. But I love them. Before the EHR, I was working in isolation. On receiving a biopsy to diagnose, my only information about the patient's clinical history was a code number or two identifying a clinical condition. Beyond that, it was anyone's guess.

Now I can feel like I am part of the team. I have full access to the group EHR and patient's record. Let's say I see a set of changes on a prostate biopsy that raise a certain flag for me. I can flip onto the EMR and confirm my hunch that the patient had a previous diagnosis of prostate cancer treated with radiation therapy. I can reset my mental slide review to incorporate the appearance of post-radiation changes. At other times, I can find the pathology report of a patient's original biopsy, even if it was performed by a doctor not part of our group and interpreted at a different laboratory. That helps me read the patient's "active surveillance" follow-up biopsy.

Bladder biopsies performed in the office are frequently very small scrimlets of tissue. It can be difficult for even the most diligent pathologist to determine if the architectural changes are an artifact of the biopsy or true papillary growths of a bladder tumor. A few clicks of my mouse and I can read the urologists complete cystoscopy note and learn what they saw during the procedure and just what they biopsied. It's almost as good as being in the procedure room as the biopsy is being taken.

Looking at a stained urine slide under the microscope sounds straight-forward. But being able to read the EHR lets me know if a patient has had a urological procedure in the 24 hours preceding their turning in the urine specimen. Findings that at first glance look abnormal can be explained once I know the patient just had a cystoscopy, something I might not be aware of without the EHR.

Yes, your doctor might grumble. You might regret the loss of eye contact with your provider. And you might not be a fan of all the data that the government is collecting about you.

But I love it, and it helps me give you better care!


The opinions above are those of the author and not UroPartners, LLC.


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photo credit: wuestenigel Stethoscope on laptop keyboard via photopin (license)

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