By Amy Walsh, MD

Here it is … an epic post about EHRs.

I’ve been waiting for years to write this. Literally, years.

Ever since 2014, when I was required to attend 30+ hours of unpaid training for this new EHR, I knew this post would be written. I did have the option of 10 additional unpaid training hours to become a “gold star super user.” That status would have allowed me to teach every confused doctor in our office how to log in and write their notes. Thanks, but no thanks.

I remember asking administrators, “Why do we need so many hours to learn how to write a SOAP note or document a CPE when we already know how to do that?” I never got a clear answer—just some blah blah babble about increasing efficiency and simpler, more accurate coding.

It’s weird because I can’t remember training for any other electronic device that “simplified” my life (computer, iPod, phone, or tablet). Do you?

Focus, Amy. Just write the blog.

No one disagrees: medicine is a mess. Health care is chaotic, complicated, and expensive—so damn expensive. There are plenty of problems to fix and enough blame to go around. One thing most doctors and nurses agree on that has been bad for health care is the EHR. Most large networks and hospitals have transitioned to one form of EHR or another. I’d go so far as to say that EHRs are the worst advancement to ever be introduced into medicine.

Let me explain why this is so.

1. Every provider’s inefficiency climbs. Let me say first and foremost: EHRs aren’t always built for or by physicians; instead, they are built as a coding machine for profit. EHRs are the most cumbersome documentation tool for doctors ever. Click click click click. It never ends. Notes take longer than ever. The result? A bloated note—a three-page strep throat note that now qualifies for a 99214 charge. Many times I get a consult note from a specialist, and I have no idea what they thought. The note is 14 pages of “stuff”: an outdated problem list, an incorrect med list, and an assessment and plan I can barely decipher. Did they think my patient had cancer? Did they need surgery or a biopsy? Was my differential diagnosis correct? Sometimes I can’t even tell. Sometimes, their note or summary isn’t even completed. I don’t blame them. I blame their EHR’s inefficiencies of documentation.

2. Every physician ineffectively communicates because every physician is inputting codes. EHRs have so many data entry requirements and demands for physicians to check that doctors rarely have time to communicate with their colleagues or patients. Back in the good ol’ days, ER doctors called and told me a patient was admitted or treated. Cardiologists let me know my patient was recovering after an acute MI.

Gosh, we used to talk about interesting cases.

With the implementation of EHRs, that all stopped. Everyone is too busy documenting, coding, and whatever else is required. Just get the right info entered in the right place with the right click so the higher charge can be entered.

Data, data, data.

I miss the days when real patient care and learning were higher priorities for doctors.

3. Every patient is confused. This is where things really get bad. Because of 1 and 2, patient care suffers because of these EHRs.

Patients can’t understand why doctors are constantly looking at the computers or making sure their “scribe” (we now need scribes!) gets the info entered. They can’t understand how to get ahold of their doctor. They can’t understand why it’s so hard to get an appointment, why they never get an answer to an email question, or why an Rx was sent in for them when no one explained the new medicine. Their care is given in silos, with very little communication between doctors and patients. Their care isn’t streamlined; it’s inefficient and choppy. I blame EHRs.

EHRs are a four-letter word.

There are plenty of four-letter words in medicine: heal, sick, life, call, code.

But I contend EHRs are the most hated in medicine.

Prove me wrong.

Amy Walsh is a family physician