As Electronic Health Records (EHR) become more common to medical practice, the plurality of companies and systems can make the selection daunting for clinicians who have not yet invested in the technology. While some clinicians are keen to ensure that a given system will comply with government regulations to qualify for incentives, deciding to invest in an EHR for your practice should involve careful consideration of how that system will save you time and improve your medical care. I personally feel that the government incentive should be the last factor you consider, and you should never make the transition for the incentive alone.
Ahead, I will highlight particular areas of interest regarding EHRs— from mobile technology to customizability— that deserve attention from clinicians as digital technology takes on a more significant role in the practice of medicine.
Making the Adjustment
Many clinicians' primary concern with switching to EHR is the impact it would have on the practice and staff. This echoes one of the earliest and most lasting criticisms of EHRs, which is that effective use of an EHR requires sacrificing individual clinical preferences. But as EHRs developed, customizability has evolved significantly in many systems. EHR companies perhaps aptly recognized that all physicians practice differently, because newer systems allow for easy customization to fit with the standards of a given clinician. This allows physicians to select their preferred manner of entering data and writing notes. So once you establish your routine and your customized preferences, you may find that using an EHR will actually speed you up. While there will be an initial adjustment period, it shouldn't affect the overall number of patients you see. That threshold will differ for each physician, but that is why it is essential to select a system you think best suits your individual style and one that you can customize to your liking. With my system, Modernizing Medicine, my notes are completely unique to me and will be different from those of another physician using Modernizing Medicine. I find that I see the same number of patients as I did previously, and the level of my coding has actually increased. I was able to transition completely in three days. I am also much quicker than I was when dictating notes. Once you've established your preferences and gained familiarity with the system, a good EHR should allow you to operate more quickly and efficiently, both administratively and clinically. If it can do this, the EHR can save you time and ultimately make the practice run more smoothly overall and consequently leave more time for your personal and family life.
If you are concerned about the transition or that it may decrease the number of patients you see, try selecting a system that allows you to progress at your own rate. Some systems will allow you to start with as few or as many patients as you would like, and then dictate the rest. This was a large factor in our group choosing the Modernizing Medicine EMA system. There is bound to be a little bit of mistrust with a system at the beginning, but once you gain familiarity and set your EHR to your customized preferences, your practice should benefit. The “Software as a Service” model also allows you to make the transition to EHR without the large upfront costs of hardware. This lowers your financial risk and allows you to try a system for a relatively small upfront investment.
Another element of the EHR discussion that hasn't garnered the attention it perhaps deserves is mobile technology. At this point, embrace of digital and mobile technology amongst the ranks of the medical community seems to split on generational lines, with younger physicians more adept at using smart phones and other mobile devices. In my view, mobile technology and tablet devices will play a critical role in the practice of medicine in coming years. They offer many conveniences that, especially when synced with your EHR, should allow you more time to focus on patients.
Modernizing Medicine offers a glimpse of what that future may look like by offering the ability to operate on tablet devices such as the iPad. In the examination room, my medical assistant performs all documentation via an iPad from start to finish, with almost no documentation needed afterward aside from reviewing what the MA has entered and ensuring the coding is correct.
From a practical standpoint, the iPad saves you from needing a laptop or desktop computer in all of your rooms. Its portability makes it easy to use and the transition from room to room is more natural. In addition, patients can sign consents on the iPad and very soon Modernizing Medicine will be able to take a picture with the iPad and insert it seamlessly into the patient's electronic record. Also, with an iPad, you will do less typing than if you were using a computer, because it is touch-based and not keyboard based. This may not seem like a worthwhile feature, but when you consider the amount of time it takes to type and how much we need to do it throughout the day, using an iPad saves time just by requiring less typing. You will never be able to have no typing at all, but “less is definitely more” in this case.
While mobile technology certainly has the potential to improve the convenience of documentation and various other aspects of a medical practice, it is important also to consider the extent to which your use of technology affects your relationship with the patient. I made the commitment that I would never document personally while taking a history and performing an examination, as some patients can feel put off if you are working on a laptop or iPad during your consultation. As much or as little we lend credence to it, there is a social relationship that we share with patients, and how we use technology may affect the way that patients see you. If they are not happy with that interaction, they may feel less connected with the doctor and not return, regardless of the quality of treatment you have provided them. So even though these various technologies can increase the quality of care you are able to deliver to patients by allowing you more time and causing less frustration, be sure to remain engaged with the patient at all times.
Evolution and Improvement
No matter how you approach the implementation and use EHRs and technology in general, it's important to keep in mind that this technology exists and should be used to improve the practice of medicine. There will be growing pains with every system. No matter how good a system may be, transition from paper-based documentation is difficult. There is no perfect system. EHRs are still in their infancy and they will continue to evolve and hopefully improve to meet the ever-rising standards or care that our patients require.
Jordan Miller, MD is in private practice in Flagstaff, AZ.