Letters to the Editor - May 26, 2008

EHRs must be made irresistible, but for now are clearly inadequate - Appreciation for AMA's Dr. Davis

EHRs must be made irresistible, but for now are clearly inadequate

Regarding "Selling the bitter EMR pill" (Article, April 7): The article, in essence, asks how do we convince the recalcitrant physician to swallow the bitter pill of an electronic health record. The implication is that when it comes to slow adoption of health information technology, the doctor is the problem.

We need to change the focus. The question should not be how to inveigle physicians to use insufficient technology, but rather how to improve the technology and the human structures around that technology, to make its adoption irresistible. The question should not be why is the ICU doctor struggling but rather why is the EHR failing the ICU physician.

The extra time and disrupted work flow the EHR imposes on clinicians deserves more than perfunctory mention. Make-work and work displaced to the physician is real work and takes time.

And time really does matter. I took a stopwatch with me on rounds one day, monitoring time spent with patients and time spent with computers. The result: 21 minutes with patients and 75 minutes with the computer. It took more than an hour and a half to do work that previously took 30 minutes. Understandably this is not a serious concern for hospital administrators -- our time is free to their bottom line. But it should be a concern to anyone interested in quality of health care and access. More time spent accomplishing the same work means less capacity to care for patients. It also means less time for those elements of care patients most value: shared decision-making and relationship building. While it may save hospital employees time when the physician performs the functions of data gathering and data entry, it is time taken away from other clinical priorities.

Disruption in thought flow with the EHR is another barrier to its widespread adoption. In the EHRs with which I labor it is only possible to view one screen at a time. This inhibits data synthesizing, which is critical in medical thought. The physician can not view laboratory results, x-ray reports, vital signs or other clinical measures while documenting a patient visit. As a result, in our clinic even super-users have their staff reprint much of the medical record for each visit. In our hospital physicians are handwriting lab values and other clinical data on scraps of paper for reference during order entry and documentation. Paper persistence is a work-around for poorly designed technology. The myth of a paperless system will become reality only when cognition, work flow and efficiency are supported, rather than disrupted, by the EHR.

--Christine A. Sinsky, MD, Dubuque, Iowa

Appreciation for AMA's Dr. Davis

Regarding "Fighting spirit: AMNews interviews [AMA President] Ron Davis, MD" (Article, April 14): In my 20 years as an AMA member, we've been fortunate to have a number of fine leaders to represent the Association and its mission. During that time, however, I don't believe we've had a president who has done so well at representing the members' interests by championing the issues from the perspective of our health care system and its purpose of serving patients as you have, Dr. Davis.

It's easy to say that physicians are beleaguered and undervalued and that we work hard in a system that seems designed at times to undermine our efforts. It's easy, if often disingenuous, to boast that we have the "best health care in the world" in America. In standing behind the physicians of America while at the same time acknowledging our weaknesses, advocating for positive change, and recognizing the work that lies ahead of us, you have made an important contribution to America's health.

We often fail to take the time to show our appreciation. The story of your illness serves to remind me how important it is to do so. Thank you.

--Thomas D. Wendel, MD, Sacramento, Calif.

Vote refines AMA stance on health reform
The AMA House of Delegates rejected attempts to rescind support of a U.S. House health reform bill and any new government-sponsored health insurance plan during the 2009 Interim Meeting.
Story - AMA House - Slideshow