Dr. David E. Trachtenbarg's article “EHRs Fix Everything – and Nine Other Myths” [March 2007] describes ways to address the shortcomings of electronic health record (EHR) systems. Physicians should also understand that the implementation of an EHR creates an opportunity to optimize workflow.

With paper charts, physicians typically perform most, if not all, of the documentation of patient encounters. With EHRs, physicians can continue to be the primary author of all documentation if they choose, or they can implement a team approach to record keeping if their EHR is well constructed. A good EHR provides templates and flexibility to combine discrete data entry with free text.

EHRs are often marketed as being simple and streamlined with structured templates for a variety of medical conditions (e.g., hypertension and diabetes). Ironically, with the exception of some acute visits, the typical office visit of a family physician is neither simple nor streamlined. It often includes managing multiple chronic conditions, preventive care and acute problems, and it is rarely a one-problem visit.

When our group transitioned to an EHR, my greatest frustration was feeling constrained by these templates. Once I let go of this frustration, my EHR-induced anxiety waned. I began to focus on how my staff team and our EHR could optimize the care I provide my patients.

There are numerous permutations possible. I huddle with my staff before seeing patients each day to review the schedule and determine which encounters will have a coordinating EHR template. Our medical assistant collects the preliminary information at the beginning of each patient visit, which I review before entering the exam room, and then I clarify and confirm the information during my patient interview. The assistant accompanies me in the exam room and records the encounter.

This workflow process has been liberating. I spend my time focused on the patient, not distracted by documentation or the computer. My patients seem to appreciate the improved cycle time and don't mind having an assistant present. By the time I leave the room, most of the documentation is completed.

The success of this model is highly staff dependent. With team documentation and the tools nested in the EHR, I am able to more effectively provide comprehensive and quality patient care.