From The Editor | June 14, 2012

Doctors Need To Think Outside The Keyboard

Ken Congdon, Editor In Chief of Health IT Outcomes

By Ken Congdon, editor in chief, Health IT Outcomes

Follow Me On Twitter @KenOnHIT

Data entry has always been a huge barrier to EHR adoption for physicians. Doctors don’t want their workflows and patient interactions interrupted by the tedious task of typing, and many have gotten around this issue by delegating order entry responsibilities to nurses, scribes, or other staff members. However, many fear Stage 2 Meaningful Use regulations may nullify this EHR data entry workaround. There is a measure in the proposed Stage 2 rule that allows for licensed professionals or scribes to enter patient data into an EHR on the doctor’s behalf, but many, including key members of the HIT Policy Committee, believe physicians should be required to personally enter orders. The reason? Most EHR systems display decision support data when the order is entered, and doctors will not see this valuable (and potentially life-saving) information otherwise.

Now, I’m a strong believer that physicians should see decision support information in real-time. It’s one of the key value propositions of EHR technology. However, I don’t think this should condemn physicians to a life of data entry. In fact, I know it doesn’t have to. How do I know? I’m a patient at an ENT Specialists of Northwestern Pennsylvania, a group practice that has figured out a way to ensure its doctors see every order as it is entered into the EHR, without ever typing a word or selecting a drop-down themselves. They’ve accomplished this feat by leveraging relatively simple networking and switching technologies that allow physicians to not only communicate with a remote scribe entering data into an EHR, but also see the patient chart and the data being entered — on 32-inch monitors in each exam room.

I wrote a detailed 6-page case study on this innovative solution back in January, which you can read here. However, here’s a quick summary. At the start of the work day, each doctor at ENT Specialists is assigned a remote scribe that resides in dedicated office space within the practice. The doctor communicates with this scribe via a wireless telephone headset. When the doctor enters an exam room to evaluate a patient, the physician tells the scribe the exam room he’s about to enter and the patient he’s about to examine. The scribe then accesses the appropriate patient record in the EHR system on his computer and pushes his desktop screen to a 32-inch monitor in the exam room using switching software. The doctor then verbalizes the patient exam (e.g. “I am removing compacted cerumen from the patient’s left ear using a curette,” or “The patient has a middle ear infection, let’s put him on 500 mg of amoxicillin twice a day.”). The scribe keys this procedure and order information into the EHR, and the doctor gets to see this data as it is entered, as well as any decision support prompts.

EHRs Don’t Have To Come Between Doctors & Their Patients

This solution has not only removed the burden of data entry from physicians, but it has also helped improve patient/physician interactions. Physicians often bemoan EHRs because the act of burying their nose in a computer places a barrier between themselves and the patient. For example, in a recent article in The Atlantic titled Are Computers Getting Between You And Your Doctor?, Dr. John Henning Schumann says that EHRs have caused doctors to become “tethered” to their computer appliances and have created a communication “wedge” between doctors and just about everyone else — nurses, other doctors, and worst of all patients. Schumann also states that many patients have complained that their doctor now makes more eye contact with the computer screen than with them.

As a patient of ENT Specialists of Northwestern Pennsylvania, I can attest that I do not feel a disconnect with my doctor when he reviews my EHR using the remote scribe solution. I’ll admit it was a bit odd to hear him verbalize every step of my examination, but in the end, even that was reassuring because I had a clear sense of what he was doing and why. I never got the impression that he wasn’t focusing on my needs, or was paying more attention to my chart than me. To the contrary, the fact that my chart was displayed on a 32-inch monitor for me to see sparked a deeper conversation between me and my physician. I saw things in my chart that prompted me to ask questions I never would have asked otherwise and I gained a deeper understanding of my own health in the process. Isn’t that what EHRs are all about?

After documenting the benefits of ENT Specialists’ remote scribe solution (and experiencing them first-hand as a patient), I can’t believe more practices haven’t taken this approach to EHR implementation. This is particularly perplexing given the fact that ENT Specialists has documented a financial ROI from its remote scribe EHR solution. That’s right. This innovative EHR platform improved physician productivity and allowed the practice to increase patient volumes 3.6%. The EHR was also instrumental in driving up practice revenue by 32%. I’m also shocked that an enterprising EHR vendor hasn’t taken this idea and capitalized on it from a business perspective. Imagine the advantage an EHR vendor would have if it could offer practices an EHR that eliminates the need for physician data entry out of the box? This would be a fairly simple bundled solution to pull off by partnering with a networking vendor or systems integrator. It seems to me there’s a pretty strong business case for an EHR solution like this. Or, am I missing something here?