Doctors resist electronic health records

Electronic health records (EHR), or electronic medical records (EMR) have constituted a hot topic, as my colleague Tom Lecklider pointed out in a recent article. But the attention the electronic records have received hasn’t been popular—at least among doctors. Robert M. Wachter, a professor of medicine at the University of California, San Francisco, and the author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, cites a physician recruitment ad whose key selling point is “No EMR.” He writes in the New York Times, “In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.”

Doctors, he writes, find that electronic records systems suffer from poor usability, require time-consuming data entry, generate needless alerts, and result in poor workflows. Patients don’t like the systems either because they hinder communication with the doctors. Further, Wachter adds, the systems don’t seem to prevent medical mistakes. He explains that in a study of more than 1 million medication errors, 6% were related to computer prescribing systems.

Nevertheless, he finds “utterly unpersuasive” the argument that doctors should return to three-ring binders, pens, and paper. “Health care, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and backbreaking costs,” he writes. “We will never make fundamental improvements in our system without the thoughtful use of technology. Even today, despite the problems, the evidence shows that care is better and safer with computers than without them.”

And it’s worth noting that digital health records can provide a trove of useful information that computer scientists can mine to transform medicine.

Wachter calls for improvements in the software as well as training students and doctors to focus on the patient despite the demands of the computers. And software developers need to observe how doctors use the systems—akin to the way Boeing cockpit designers observe pilots in simulators.

He writes, “Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing. An important step is admitting that there is a problem, toning down the hype, and welcoming thoughtful criticism, rather than branding critics as Luddites.”