"First, do no harm" is a fundamental precept to medical ethics and a guiding light for the delivery of care. Physicians take on the laudable act of healing -- a superhuman undertaking that unfortunately cannot be done with a wand or wiggle of the nose.
The work of doctors is masterful; in part because over the years their technological toolkit has grown to include new innovations that serve, enable -- and in some instances automate -- clinical tasks to improve care processes and even save lives. But with advancement comes a learning curve and adaptation, and as we've seen with electronic health records (EHR), usability remains a widespread hurdle.
Last month, The New York Times covered the topic of EHRs in a piece so aptly titled, "Seeing Promise and Peril in Digital Records." In it, a 2009 study by the National Research Council was referenced that found electronic health record systems are often poorly designed, and so could "increase the chance of error, add to rather than reduce work flow and compound the frustrations doing the required tasks."
Beyond this study, there are doctors' firsthand testimonials that identify usability as a major issue and concern. Listen to Dr. Nairus, orthopedic surgeon, in this video:
To summarize, Dr. Nairus says "I don't think any physician, at least that I've talked to, has been thrilled at having to switch to the EHR. It creates more work for us." Dr. Nairus echoes the voice of many doctors when he goes on to say, "You have to come up with a system to limit the pain."
It's somewhat ironic that doctors must "limit the pain" EHR systems inflict on them as part of their broader mission to cure and heal patients. So, what is the treatment plan for the thousands of doctors who are suffering the pain of EHRs? According to Dr. Nairus there are three options for doctors working to incorporate EHRs as part of their patient care and clinical documentation workflow:
- Document 100 percent in the EHR by leveraging templates: This method is fast if you're an able typist, and oftentimes will get the appropriate level of documentation. However, as Dr. Nairus points out, template-driven notes can seem "canned" and "not personalized," making it difficult to capture, understand, share and preserve a patient's full story.
- Personalize notes within the EHR to ensure patients' records are rich with detail: This can be done through comprehensive typing or with the support of a medical transcriptionist. The catch here, as Dr. Nairus shares, is that typing is timely and for many doctors it is burdensome. Alternatively, medical transcription can result in highly-detailed notes sent to the EHR, based on doctors' recorded dictations. However, often this is expensive and can be delayed by hours or days.
- Put the patient story into words and into the EHR in real-time: As part of the health care industry's transition to EHRs, step one is making clinical data digital and step two is making digital data meaningful. To derive the utmost value from an EHR, there must be two kinds of information captured: 1) Narrative: the patient's story, the doctor's story/decision making rationale 2) Data: critical, relevant information, including patient complaints, physician-assessed diagnoses, allergies, social habits and more, that can be extracted and encoded into standardized medical vocabularies and shared across the continuum of care
As Dr. Nairus points out, speech-driven documentation may be the most practical way to create patient documents -- both now and in the future. When paired with the EHR or with medical transcription workflow, speech technologies allow doctors to tell a story with their voices. While some doctors prefer to type, it's not always practical. Manual entry requires a desktop, a keyboard, a mouse -- and time. If a doctor can't get to his or her desktop, should documentation wait? What today may be about limiting the pain of the EHR, will tomorrow translate into leveraging a data-rich EHR to promote smarter, better care.