Guest Column | July 7, 2017

AMA EHR Initiatives: What They Mean For Tomorrow's Doctors

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The AMA recently announced two separate initiatives around EHR training for next-generation doctors: the AMA Health System Science Textbook and the AMA’s Accelerating Change in Medical Education initiative. Given the many hurdles doctors face with EHR adoption, these initiatives are being put in place in an effort to teach providers how to use the technology to assist with enhanced care delivery.

In light of these initiatives, Health IT Outcomes spoke with Jennifer Sun, M.D., clinical product manager at PatientKeeper, Inc. to get her take on what this means for tomorrow’s doctors. Here’s what she had to say.

Q: From a physician’s perspective, why do you think the AMA is putting forth these initiatives to enhance EHR learnings for the next generation of doctors?

Sun: The recent AMA initiatives strike me as similar to when the organization recommended adding business topics to medical education, like malpractice and documentation, in response to feedback from practicing doctors. I also think medical schools are constantly adapting to add things students have given feedback on — for example, Dartmouth added a “death and dying” elective and complementary medicine electives when I was in school.

Q: What would you consider to be the pros and cons of these initiatives?

Sun: The pros of these initiatives are doctors gain a basic understanding of what EHRs can do and what physicians are required to do in those systems. Getting dumped into the “real world” of medicine never having touched an EHR would be insane, though highly unlikely considering what you have to do in residency.

In terms of cons, whatever EHR you might learn about in med school probably would be out of date three to five years later when you are out of residency. In addition, your residency most likely would use a different EHR from whatever “demo” system they have set up for medical students to try. The med school curriculum is already jammed full, so what do they cut out to add this new content? Additionally, students will have the chance to learn EHR capability and functionality as part of their clerkships in third- and fourth-year because, presumably, they will be using those systems to check results, write notes, etc.

Q: Should tomorrow's doctors be questioning how their EHR works rather than simply learning about the functionality?

Sun: Having done an additional fellowship in medical informatics after my residency, I think having a foundation in what these systems can potentially do for you as a part of your workflow would be helpful. It is valuable to gain a sense for how the computer can assist in diagnosis, security issues with EHRs, documentation issues with EHRs, and how to use alerting to its most efficient/useful capability.

But asking future physicians to learn how to operate a specific EHR system — point here, click here, check these boxes to document your physical exam — are all just actions and they’re forcing physicians to use a system that may not suit their workflow. Pointing and clicking on different areas of the screen requires that you look at the screen during the entire office visit, which impedes the doctor-patient relationship. Leaving all charting until after each patient encounter would make doctors super inefficient if they’re seeing 30 patients every four hours. Having physicians become advocates for tools that support their workflow would be a much better use of technology education. A surgeon will have different workflow than a pediatrician, but both should know some general features about an EHR to be able to question whether the system has to work the way it currently does, or whether it could be customized to better fit their office and their practice.

Q: Looking ahead, do you believe doctors should have a say when it comes to future healthcare technology design and functionality? Why or why not?

Sun: Physicians definitely should have a say. I hear from too many friends and colleagues that they are “behind on their charts.” Why is that? What is making the documentation so difficult or tedious they can’t put together complete documentation of a visit, covering everything they did, without it being a million clicks? Or knowing where to look for a rare lab result or how to refer a patient to a specialist? Why does it have to be difficult to get results that were done at another lab, on another radiology system, in another state or country? Why has it been such a fight to have data be sharable between sites?

There are many stories of EHR deployments gone bad for lack of specific physician input or insufficient medical staff involvement. One hospital I worked at had to shut off its new CPOE system for all the ICUs for six months due to lack of support for complex IVs. Perhaps that problem could have been avoided with greater physician involvement up front.

If physicians don’t speak up for what is not working in their workflow, we’ll be overrun by requirements to click this, document that, etc. — and eventually the documentation will be so long and ridiculous no one will read it anyway unless you’re getting sued.

Q: If you could tell tomorrow's doctors one thing about using an EHR in their practice, what would it be?

Sun: Ask lots of questions. Ask with specific examples of your own workflow to be sure that what you actually do is supported.