Big Data Fantasies Of A Primary Care Doctor

By Linda M. Girgis, MD, FAAFP

An uncooperative EHR system drives a primary care doctor to the brink

As I spend yet another weekend in the office catching up on my charting, I find my mind wandering to how my EHR was designed to taunt me. Let me explain.

I am a big preventive medicine proponent and have spent hours developing measures in my EHR system of what preventive health services my patients need, as well as when they need them. When a patient comes in with a sore throat, I am alerted by a pop up box that they need a prostate exam. When I receive an electronic task that they need their blood pressure medication refilled, that pop up box again appears, reminding me of the overdue prostate exam. As I go through my account receivables at the end of the month, I am once again alerted by the pop up box of the same patient and his overdue prostate exam.

That’s three reminders in one week about the same patient’s prostate and I have no way to get rid of the alert without changing the whole notification system. I find myself fantasizing about individualizing these alerts, but my EHR system won’t let me.

The inability to remove redundant alerts is just one of the frustrations I experience with my EHR systems. Others include:

• Inconsistencies within and between EHRs
  My system allows me to pull up all my patients with diabetes, and I’ve used this feature in the past to remind them to schedule an appointment for an influenza vaccine. I’d like to do the same search for all my male patients who are overdue for a prostate exam, but my system doesn’t allow me to search for all patients who are overdue for a specific preventive health item. I have seen other systems that allow for this type of search and would love it if mine could. Another PCP fantasy.
• EHRs aren’t flexible or customizable
  In order to simplify my job and allow for more time with patients, I developed templates with pre-worded sentences that can be altered as I see fit – something the system did not come with. This modification improved my efficiency, helps me locate useful information easier, and helps standardize my charts. Now, I am seeing a great deal of media hype about the possible negative implications of copying and pasting notes. I think that we, as doctors, should be the ones who control how the note is documented and if EHRs came with the ability to copy and paste I wouldn’t have had to create a work around, possibly putting myself at risk.My point is doctors need to individualize their charting methods to what works best for them. For me, I keyboard all my notes which helps prevent me from making "point and click" mistakes while other doctors may be more efficient at the "point and click" method. This works in my practice which consists of me and my husband - he dictates, I keyboard. But what if I worked in a large groups or hospitals? I’d be forced to adapt to methods of inputting data that may make me less efficient and results in errors.

• Communicating with other physicians
  I often request notes from other physicians and find it is difficult to locate the information needed as every EHR system is formatted differently. It can be mind boggling to look at the many different formats of notes and would be ideal to have some standardization between systems.
• Communicating with insurance companies
  Insurance companies do periodic chart reviews and require help to read EHR records which often results in me dedicating one of my staff just to sit and help them completely at my expense. Personnel working in positions requiring the need to access EHRs should be more appropriately trained. I have had a few auditors ask for hundreds of pages printed out because they could not understand the EHR note.

Primary care physicians serve a key role in the healthcare system. We are more often than not the first doctor a patient contacts for any given disease. We are responsible for referring patients to consultants and doing prior authorizations for procedures. Our medical notes are probably examined more often than any other specialty and need to be a way to communicate between doctors and medical personnel. While big data is good, it can be better. It would benefit us all to make systems more individualized to make them easier to use by each physician, but standardized in their readability. The power of big data truly needs to be harnessed and the fantasies of primary care physicians made reality.

About The Author
Linda Girgis, MD, FAAFP, is a board certified family doctor with Girgis Family Practice. Dr. Girgis studied medicine at St. George's University School of Medicine and served her residency at Sacred Heart Hospital in Allentown, PA.