Efficient or obtrusive? Exploring the controversy over electronic health records

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September 12th, 2013

Dr. Peter Lueninghoener sits in his office at Elkhorn Valley Family Practice in O'Neill, Neb. (Photo by Hilary Stohs-Krause, NET News)

Dr. Peter Lueninghoener sits in his office at Elkhorn Valley Family Practice in O’Neill, Neb. (Photo by Hilary Stohs-Krause, NET News)

Lincoln, NE — Electronic health records are one of the most controversial aspects of healthcare reform. While some Nebraska experts say they’re a lifesaver – literally – others argue they’re cumbersome and actually hinder healthcare workers instead of helping them.

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Dr. Peter Lueninghoener consults with a nurse about a woman going into labor at Elkhorn Valley Family Medicine in the north-central town of O’Neill.

Lueninghoener’s desk and a peg board are littered with calendars, printed articles, scribbled post-it-notes and stacks and stacks of file folders and documents. Two mounted deer stare down from the wall.

The plethora of paper might not seem strange until you realize that Lueninghoener’s  practice uses electronic health records and so is technically paperless. He laughs when I point out the seeming inconsistency.

“There are a lot of things that were a lot easier with paper,” he said. “The old paper way, I sure can’t knock it, because it worked very well. But there are so many advantages to the electronic, and we’re just beginning to touch the tip of the iceberg.”

As of 2010, a quarter of office-based physicians in Nebraska were using at least a basic electronic health record program, or EHR, according to a federal report.

When it comes to hospitals, last year Nebraska ranked 20th nationally for EHR use. Nebraska matches the national rate – about 44 percent – and that number has tripled since 2009.

But why the rapid increase? What do electronic health records even do?

Kayleigh Johnson, a registered nurse and the assistant director of nursing at Family Practice Associates in Kearney, Neb., said EHRs save a lot of time.

“It’s helped our patient care quite a bit,” Johnson said. “Everything’s right there at your fingertips. You don’t have to spend hours digging through charts. So I think a lot less gets missed.”

An example of electronic health record software; this is from Allscripts Professional, one of the most common programs used by Nebraska health care providers. (Courtesy image)

An example of electronic health record software; this is from Allscripts Professional, one of the most common programs used by Nebraska health care providers. (Courtesy image)

Johnson, who worked at the Kearney clinic during their switch from paper to EHR, says digital medical records help providers keep better track of patients: when they need check-ups, giving them lab results sooner, and providing easy access to information on their allergies and medications. Essentially, proponents say, electronic records cut down on human error. But the transition from paper to PC can be tough.

“You have to be patient with it. It takes a while. Everybody’s going to get frustrated,” Johnson said.

Todd Searls oversees Wide River TEC, a statewide program to help primary care providers, small clinics and rural providers transition to EHRs. He said the cost of that transition is often a big concern.

“It’s definitely something that has been painful for a lot of providers, and understandably so,” Searls said. “Especially in Nebraska, where we’re predominantly a rural state. There just aren’t a lot of resources. Then we talk about staffing concerns, in terms of getting their staff up to speed and trained, and then it goes more into the practice and workflow disruption that occurs.”

According to a 2012 report from the U.S. Centers for Disease Control, 85 percent of physicians who have adopted an EHR system reported being somewhat or very satisfied. About 75 percent reported that using their EHR system resulted in better patient care.

 

But not everyone agrees. Last year’s National Physicians Survey found a roughly equal number of physicians said EHRs will cause patient care to deteriorate, will improve it or will cause it to stay the same.

“EHR probably is the single most disruptive element in today’s healthcare,” said Dr. Dmitry Oleynikov, professor of surgery and director of minimally invasive and robotic surgery at the University of Nebraska Medical Center in Omaha. “The perceived benefit is that somehow, all this information, all this data, will enhance or improve patient outcomes, which is not true. It’s not designed for that. EHRs are designed to meet guidelines that are created by individuals who frankly do not understand what matters when it comes to good or bad patient outcomes.”

Oleynikov is referring to “meaningful use” standards created by the federal government. The stages of meaningful use – there are currently three – are like mile markers for clinics and hospitals. Eligible health care providers can earn incentive payments by meeting these mile markers.

The other major complaint with electronic records? They’re cumbersome.

Christopher Novak is the vice-president and director of operations for MacPractice, an Apple-based EHR and medical software company in Lincoln.

“The term I’ve heard is ‘click happy.’ You have to click here, click there, click here, do this, and it takes you twice as long to fill out your patient health information in EHR as it would to fill it out on paper.”

Novak says this stems in part from federal reporting requirements, but that it’s an aspect of electronic records software the industry is trying to improve. Johnson said much of that lag time is attributable to the complexity of EHR programs.

“There was a huge learning curve with it,” Johnson said.  I would say it took us a year to get fully comfortable, and two years later we’re still finding new ways to make things easier.”

But despite the initial hurdles, Johnson said she would hesitate to return to a paper clinic.

“Everything in there is so organized, and each person can kind of map it the way that they want, and it just makes it so much easier,” Johnson said.

UNMC’s Oleynikov says digitizing records is valuable; it’s the current methods of doing so that are inadequate, he says, turning physicians into “glorified data-entry specialists.” But for better or worse, more and more healthcare providers in Nebraska are choosing that method.

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