Why Are Patients Anti-EHR?

By Ken Congdon, editor in chief, Health IT Outcomes
Follow Me On Twitter @KenOnHIT

Xerox Healthcare and Harris Interactive released the results of their third annual Electronic Health Records (EHR) online survey last month, and as a health IT advocate, I found the findings concerning. Of the 2,147 U.S. adults that participated in the survey, only 26% stated that they wanted their medical information recorded electronically. My initial reaction to this data was to cry out “Who are these people!?” Don’t they understand the impact EHRs can have on the streamlining clinical documentation and improving their quality of care? Then, I took pause, and quickly realized that the answer to this question is a resounding “No.”

Not only do most patients not understand the value of EHRs, but many probably view the technology as an unwanted change, and even a nuisance in some instances. Chad Harris, group president of Xerox Healthcare Provider Solutions issued the following response to the research. “We continue to see a resistance to change from consumers — meaning providers need to continue to educate Americans on the value of EHRs.” This is a nice sentiment, but I feel it’s slightly off target. In fact, I would argue that most health providers only serve to perpetuate the negative feelings most patients have towards EHRs.

EHRs Can Positively & Negatively Impact The Patient Experience

Let me explain. I may be a health IT journalist, but I’m also a patient. As a patient, I’ve visited several physicians on behalf of myself and loved ones. All of the physicians I’ve interacted with over the past few years have adopted EHR technology, but most don’t use it well. In fact, most are noticeably uncomfortable using the technology and frustrated by it. I always make it a point to ask all of the doctors I visit about the EHR technology in use and how they like it. Most jump at the opportunity to tell you what a piece of junk their EHR system is and how it is ruining their professional lives. In fact, I’ve only encountered one health provider as a patient that actually embraces the technology. The patient experience at this facility is a far cry from the experience I receive at facilities where physicians are disgruntled EHR users.

Allow me to illustrate. A few weeks ago I needed to take a relative to the ER with chest pain. An ER nurse saw the patient first, asked a few questions, took vitals (e.g. temp, blood pressure, etc.), and typed the responses/results into the EHR. Most of the questions focused on what the symptoms were, when they began, what the patient was doing at the time, what prescription medications the patient was on, etc. A few minutes later, an ER doc came in with a laptop, asked many of the same questions, and hunt-and-pecked the data into the computer. He sighed on several occasions, and rarely made eye contact with the patient. He seemed more focused on getting the information recorded than evaluating and comforting the patient. After the data was entered, the ER doc ordered some tests and left the exam room. After initial tests were run, a cardiologist came in to examine the patient. He too asked many of the same questions and hunt-and-pecked. At this point, my relative was visibly frustrated about having to answer the same questions over and over. I thought to myself, “Isn’t this exactly the type of inconvenience that EHRs are supposed to help eliminate for patients?” I told the cardiologist that we’ve already answered these questions, and wondered why he couldn’t access them from the EHR system. As it turns out, the ER and the cardiologist used different EHR systems that weren’t interoperable. The cardiologist had to re-enter the information into his EHR so he had a record of the patient.

Let’s contrast this experience with the experience I regularly receive at ENT Specialists of Northwestern Pennsylvania — the EHR advocate I referenced earlier. I previously documented my positive patient experiences at this facility in a 6/14 article titled Doctors Need To Think Outside The Keyboard. Every time I visit ENT Specialists, my electronic patient record is displayed on a 32-inch monitor in the exam room for me to see. The doctor knows exactly why I am there, the prescriptions I am on, and reviews my patient history with me. He asks questions, performs his exam, and enters new information into the EHR, but he does so in a way that doesn’t compromise physician/patient interaction. He doesn’t use a computer, laptop, or tablet to enter data. He just uses his voice. He’s connected via wireless headset to scribe that enters the data into the EHR while he watches. The doctor isn’t frustrated by the technology because it doesn’t interrupt his workflow. In fact, it’s helps to streamline it in such a way that he is able to see more patients on a daily basis.

Patients Take Cues From Their Providers

The examples provided in the previous paragraphs are not meant to discount other patient concerns regarding EHRs. Surely, as the Xerox study indicates, questions surrounding health data security also serve to influence patient EHR apprehensions. The point of these examples is to show that patients take cues from their doctors. If doctors view EHRs as an obstacle or a nuisance, it’s likely that patients will as well. Conversely, if doctors embrace EHRs, it’s likely that patients will embrace them too.

Are physicians to blame then for the overwhelmingly negative public opinion of EHRs? Not necessarily. Most doctors don’t like EHRs because they interrupt their workflow. Not only do EHRs interrupt their workflow, but doctors can’t see how this workflow interruption benefits them, their patients, or their healthcare organization. Often this is the result of poor EHR technology, poorly implemented EHR technology, or not involving the physicians in the EHR decision-making and implementation process. We can’t expect health providers to educate Americans on the value of EHRs as Harris suggests until we as an industry do a better job of educating providers of the value of the technology.