I was in Miami recently to give a talk on diabetes when a physician, Pablo Michel, MD, asked me whether we could address an issue that’s important to him and many of his colleagues. His question was, Do we have any suggestions about how to help “older doctors” such as himself deal with electronic health records?
One of the problems with his question was that he didn’t really look “old”; he looked like he was about 50 years of age and in good shape. This physician had come on a Saturday morning to spend 4 hours learning about diabetes, which made it clear that he cared about his patients, his craft, and staying current with the medical literature.
Further discussion revealed that he also was bothered about what he saw happening on many consult notes that he received, as well as the undermining of history and physical notes by copy and paste; the inclusion of a lot of meaningless information made it hard to find information that was relevant. He said that he had become used to doing his old “soap” notes in a really efficient manner and found he was now slogging through mud having to reproduce large parts of the chart in every note that he did.
I was struck by his questions, as well as his concern for both the quality of care for his patients and the issues he and his colleagues were facing. And it is not just him. Increased computerization of practices has been listed among the top five causes of physician burnout.1
A recent article in Annals of Internal Medicine showed that physicians spent only a quarter of their total time directly talking with patients and 50% of their time on EHR and other administrative tasks.2 It is likely that, among older physicians, the EHR takes proportionally more time and is an even larger cause of burnout. Given the importance of EHR, it seems time to revisit both the dilemma of, and propose some solutions for, this common problem.
One of the core issues for many older physicians is an inability to type. If you don’t type well, then entering a patient’s history or documenting the assessment and plan is unduly burdensome. Ten years ago, we might have suggested learning to type, which was an unrealistic recommendation then and, fortunately, is unnecessary now.
Now, solutions ranging from medical scribes to voice recognition have become commonplace. Voice recognition technology has advanced incredibly over the past 10 years, so much so that it is used now in our everyday life. The most well-known voice technology in everyday life might be Siri, Apple’s voice technology. It is easy now to dictate texts and to look up information. Similar voice technologies are available with the Amazon Echo and Google Assistant.
We now also have the advantage of well-developed medical voice recognition technology that can be used with most EHRs. Although some doctors say that the software is expensive, it can cost about $1,500 for the software and another $200-$300 for a good microphone, as well as the time to train on the software. But that expense needs to be weighed against the lost productivity of not using such software. A common complaint we hear from older doctors is that they are spending 1 to 2 hours a night completing charts. If voice recognition software could shave off half that time, decrease stress, and increase satisfaction, then it would pay for itself in 2 weeks.
Another issue is that, because the EHR enables so many things to be done from the EHR platform, many doctors find themselves doing all the work. It is important to work as a team and let each member of the team contribute to making the process more efficient. It turns out that this usually ends up being satisfying for everyone who contributes to patient care. It requires standing back from the process periodically and thinking about areas of inefficiency and how things can be done better.
One clear example is medication reconciliation: A nurse or clinical pharmacist can go over medicines with patients, and while the physician still needs to review the medications, it takes much less time to review medications than it does to enter each medication with the correct dose. Nurses also can help with preventive health initiatives. Performing recommended preventive health activities ranging from hepatitis C screening to colonoscopy can be greatly facilitated by the participation of nursing staff, and their participation will free up doctors so they can have more time to focus on diagnosis and treatment. Teamwork is critical.
Finally, if you don’t know something that is important to your practice – learn it! We are accustomed to going to CME conferences and spending our time learning about diseases like diabetes, asthma, and COPD. Each of these disease accounts for 5%-10% of the patients we see in our practice, and it is critically important to stay current and learn about them. We use our EHR for 100% of the patients we see; therefore, we should allocate time to learning about how to navigate the EHR and work more efficiently with it.
These issues are real, and the processes continue to change, but by standing back and acknowledging the challenges, we can thoughtfully construct an approach to maximize our ability to continue to have productive, gratifying careers while helping our patients.
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