11 Undeniable Truths About EHRs and Paper Charts


How do I loathe EHRs? Let me count the ways...

From the outset I knew electronic health records (EHRs) were yet another boondoggle. Too much money was being thrown at this technology that had not been tested on very large scales, was burdened with too many associated mandates, and generated way too much upfront hype over functionality. The fact is, most providers hate EHRs, and they are now cited as a huge source of provider burnout.

Yes indeed, the federal government and its sycophant medical academicians came galloping in to rescue us from mediocrity with the promise of digital heaven. What we got instead were tickets to digital hell. For all of their promise, I give EHRs a grade of F-.

Before I continue with this itinerant screed, I should point out I have seen and evaluated at least a dozen different EHRs over the years and the only real difference among them seems to be the amount of frustration, anger, or outright hate they engender in the end user. This is always in direct and opposite proportion to the enthusiasm of the vendor who is selling them.

In the very beginning, do you remember how good it all sounded? So easy to use; no more paper to shuffle around; easy and quick access to a patient's medical information; and global interconnectivity with all healthcare providers and stakeholders? Has this actually been your experience, doctor?

I will begin by substituting the word "easy" with the words "absurdly and monumentally frustrating." I can never get my EHR to do what I want it to do (what I need it to do) when I need it to do it. There isn't a programmer on the planet who can make these things work in the way primary care physicians think or solve problems.

Here is the big obvious problem: If you need an amanuensis, factotum, or scribe to enter information into an EHR on your behalf in order to get all of your work completed, then the EHR is too complicated, cumbersome, or unsuitable for the doctor to use. This is inefficiency at its worst -- the exact opposite of what was promised.

It seems I have more paper to shuffle now than when I used a paper chart. Paper still floods into my office in the form of solicited and unsolicited medical information such as letters, reports, and test results.

Coming in, all of these bits of information must be scanned into the EHR, where, anon, the data seems to disappear into an unsearchable digital ether. Requested outgoing information must be pulled up, printed out, and faxed or mailed because hardly any of these systems communicate with one another.

If I had to choose the biggest failure of EHRs it is this one: The smart wizards at the federal level mandated us to use EHRs without providing rules or mandates for interconnectivity. My radiology group can't drop an x-ray report into my patients' EHRs because their system doesn't interconnect with my system. It's the same for the lab service we use.

I can't retrieve a patient's information about their last hospitalization from any area hospital for the same reason. This means all reports must be faxed. This defeats the premise that all patient information will be instantly available, all of the time, to anyone who needs it.

Here are 11 undeniable truths concerning EHRs:

1. EHRs are a continuous interference in the good and proper care of patients. Many superlative assumptions are still being made about EHRs with either little evidence to back them or rock solid evidence to the contrary.

2. EHRs were not created for the sake of the doctor-patient relationship. They were created by bureaucrats for bureaucrats as a means of oversight and control. We were told EHRs would improve outcomes, because that sounds noble.

3. EHRs do not make physicians more efficient.

4. EHRs are not cost effective, and the ROI for the doctor-patient relationship is vanishingly small or non-existent.

5. EHRs frustrate more than they facilitate.

6. EHR use is in violation of the Hippocratic oath because "click errors" can and have harmed patients and doctor-patient relationships.

7. EHRs slow physicians down and create more work than they alleviate.

8. EHRs are inherently fragile systems.

9. EHRs may have eliminated some errors, but they have created a whole host of new and worse ones.

10. EHRs are unnecessary for improving patient care, which can be consummately accomplished without them.

11. EHR use has yet to demonstrate valid risk reduction (morbidity and mortality) in patients over and above the use of paper charts.

Each year, more and more private physician offices are ripping up their payer contracts, getting rid of their EHRs, and thriving.

Here are 11 undeniable reasons to take a hammer to your in-office digital EHR and use paper charts instead:

1. A paper chart can never be hacked.

2. Paper charts are tangible and occupy a physical space. I have no idea where a patient's EHR information resides, not really.

3. A paper chart will never reboot while you are using it.

4. A paper chart will never "go down" while using it.

5. A paper chart has no battery to recharge.

6. A paper chart doesn't require WiFi.

7. Information can be located and visually scanned faster with a paper chart.

8. Paper charts will never "prompt" you to enter information that is extraneous or unimportant for the proper care of your patients.

9. Paper charts never inappropriately question your decision making.

10. Paper charts never need upgrades and require no maintenance fees.

11.) Paper charts do not break if you drop them.

I am sure some will read these remarks and argue for the benefits of EHRs. For some sub-specialists, who frequently use templates because encounters and procedures are consistently similar from one patient to the next, I can understand why they love them. So, too, for the academicians who love them but see comparatively few patients in a day.

However, for most primary care providers, EHRs are a living waking nightmare. They have contributed heavily to feelings of work overload, lack of control, and even conflicting values, all of which are causes of burnout.

If you feel I have left any items that are meaningful to you off these two lists, please add them in the comments section.

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