May 2008 Table of Contents

LETTERS

Fam Pract Manag. 2008 May;15(5):11-12.

e-Nirvana: We're not there yet



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The Opinion piece by Christine A. Sinsky, MD [“e-Nirvana: Are We There Yet?” March 2008] generated a flood of letters, the overwhelming majority of which expressed enthusiastic support for her point of view. Below are excerpts from selected letters. – FPM

I'd like to add my “amen” to the Opinion piece by Dr. Sinsky. I learned to program computers when I was 12 years old, and I went on to get a degree in electrical engineering before going to medical school. Health care software is currently dangerous to use, and no one knows that better than the doctors trying to use it.

I appreciated Dr. Sinsky's comments concerning the government's push for clinicians to get electrified. I sent an $82,000 electronic health record system (EHR) proposal for my office to the senators and congressmen in my state. My question to them was simple: How do we pay for this system and endure a 10.6 percent cut in Medicare reimbursement? They replied with a canned discussion of their health care priorities and issues they support, but nothing that demonstrated an understanding of the financial burdens and gaps in technology that we are dealing with. There is a lot of rhetoric from Washington, but as with many other pertinent issues, there is no commitment in terms of dollars and sense. At this point, I know more about electronic records and product choices than I care to.

My compliments to Dr. Sinsky on a fantastic article. It should be required reading for anyone interested in the state of EHR adoption by physicians. Although I am an enthusiastic EHR user, she articulated all of my frustrations as I never could.

Many thanks to Dr. Sinsky for expressing so succinctly my own feelings regarding the current state of EHRs and explaining some of the reasons that this technology has fallen short of what administrators and politicians envisioned. I am one of the “dinosaurs” who finds our office EHR to be cumbersome and, worse, a potential contributor to errors in patient care. Most of the currently available systems do not lend themselves to efficiency in the primary care setting and need major refinements before they will improve our professional lives and our ability to care for patients. I will happily and fully embrace this technology once it truly meets our needs.

Dr. Sinsky's comments are right on target. In my previous job I used a popular EHR for seven years. Now we are introducing the same system into my new practice. This particular EHR is adequate, but it and others are in no way ready to do the things the pundits say they can. A lot of individual effort is going into using these systems with very little reward. Doctors have been turned into data entry technicians and, honestly, we make very poor ones. The EHR will someday be an indispensable medical tool. As Dr. Sinsky points out, when it becomes truly useful we won't have to force anyone to use it. Physicians will demand it.

Thank you for Dr. Sinsky's sobering acknowledgement of the elephant in the health information technology room. EHRs aren't all they're cracked up to be. Physicians are not technophobic Luddites. In fact, we love technology. We tend, if anything, to be enthusiastic early adopters of the newest bells and whistles – assuming (often wrongly) that good evidence of benefit will follow eventually. EHRs don't do well most of the things that we need them to do.

No one had to browbeat me to put a computer at my desk years ago. I use it daily for e-mail, journal searches, CME, billing, shopping, music and many other tasks the computer has simplified and improved. Remember the weighty tomes of the old Index Medicus?

Someday, I am sure EHRs will improve the quality of patient care. I will probably get on board before then, resigned to “prestructured text that conveys almost no useful content” and spending more time as “unit secretary, transcriptionist, pharmacist, receptionist and medical records clerk” and less engaged in “medical decision making and relationship building,” as Dr. Sinsky said.

Thank you for not jumping on the EHR bandwagon without periodically considering the reality of the current generation of EHRs – a reality that is apparent to the majority of practicing physicians.

As a veteran EHR user, I read Dr. Sinsky's comments with interest. She makes good points that I hope will not discourage physicians from purchasing an EHR but will give them guidance when choosing one.

The information in my EHR is easy to locate: One click and I'm there, or even better, the data (such as labs and health maintenance) automatically flow into the progress note. Lab tables are designed (by me) to present information logically where it can be easily read and acted upon. I choose new medications with minimal key strokes. Template notes are easy to follow. I'm reminded of routine health maintenance and disease management needs through pop-up reminders and messages in progress notes.

EHRs do require a lot of work to implement. The implementation and upkeep are ongoing. Our practice has realized great savings and huge quality gains that are not typical because we continue to work with our technology to get the most out of it. I encourage others to go ahead and buy the “car” while realizing that although the ride could be bumpy, it can take you a lot further down the road than the old bicycle ever could.

I only have one thing to say about the article on health information technology by Dr. Sinsky: I wish I had written it! Her description of the daily exasperation of using an EHR is so on target that it is funny and sad at the same time. Thank you, if for nothing else, for teaching me that there is at least one other person who understands.

Dr. Sinsky has written a fabulous article that echoes my thoughts and experiences dealing with an unfriendly EHR system. This article should be made available to every EHR vendor, legislator and health care policymaker as it accurately reflects the struggles of many. The AAFP would do well to share it in lobbying our legislators or other interested parties on the subject. Physicians aren't dumb; there is good reason for our caution.

WE WANT TO HEAR FROM YOU

Send your comments to fpmedit@aafp.org. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.

Copyright © 2008 by the American Academy of Family Physicians.
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