To discuss EHRs is to discuss time.
From their inception, EHRs were lauded as a potential time-saver. Less time would be needed searching for records and moving lab or imaging results between clinics, departments, or specialists. More time would be available for face-to-face interaction between patients and providers. The bottom line value proposition of EHRs was that healthcare would improve thanks to time savings and efficiency.
Time has passed and the way we talk about EHRs with respect to time isn’t positive, which isn’t an intrinsic fault with the technology.
There’s still a sizeable legacy of resistance to EHR usage in healthcare, a “you can lead a horse to water” syndrome that continues to block improvements and productivity offered by the technology. There is no question that a significant part of the problem is not the tools or the systems, but the users – specifically the clinical users. In my experience, this resistance is quantifiable and directly felt in the patient, clinic, and administrative experiences.
At a clinic where I work, any given patient encounter will vary in total length (e.g., the amount of time spent on charting, direct care, reporting, and all other clinical as well as administrative functions involved to complete a single patient encounter) by as much as 100 percent. In other words, it takes twice as long to handle some patient cases as others. The difference is not the patients themselves, nor the complexity of their cases, it is the workflow and technological capabilities of the provider running the encounter.
Some providers transparently refuse to learn an EHR-driven system. That doesn’t mean they refuse to use the system, just that they refuse to become proficient or even efficient users of the software. Some of these providers will leverage medical scribes to streamline the process. In about half of such cases, scribes lead to measurable improvements. The other half, remarkably, manage to take nearly as much time as they would on their own, as they micromanage the workflow of the scribes to the point where all efficiency is lost.
It is impossible to standardize the workflows and utilization patterns of medical scribes because a given provider will demand different types of support and performance. Some providers, to their credit, learn workflows from their scribes rather than prescribing a workflow. In these situations, scribes are elevated from task specialists to teachers, and there is an almost immediate, significant reduction in the time required per patient encounter.
Only as quick as the slowest person
The share of providers willfully resisting the shift to digital are not few enough to count as outliers. Even if they were, the clinic’s reporting would not be able to exclude them from calculating overall performance, patient experience, use of resources, or any other metric of consequence. Time, it should come as no surprise, is among the more valuable resources a clinic has. Clinical time must be measured and dispensed more carefully than even the most expensive and highly regulated medications – it must be tracked, shared, and managed more diligently than any other shared resource, care plan, or innovation.
Physicians have many reasons to complain that their time is no longer their own, that they are being made to do too much with too little time, and that they deserve some return of autonomy where it concerns their time. However, they are culpable in the time-creep phenomenon.
There is no doubt that physicians’ time is the most valuable – in terms of profits – of any employee in a typical clinic. These resistors must be presented with the data that shows a positive return when time is devoted upfront to learn and adapt to the EHRs being used then to continue in a long-term pattern of resistance.
I am no EHR apologist, nor am I a breathless technophile obsessed with the potential of all things shiny and new. But, we can’t honestly assess the tools at our disposal if we aren’t being consistent in using them correctly. I don’t believe my clinic is the only one with this problem.
A band sounds only as good as its weakest musician. A clinic is only as efficient as its slowest provider. The digital resources we have at our disposal contain many generations of improvements, countless refinements and upgrades to get them operating at peak potential and with increased autonomy. The habit of putting off adaptation and shifting blame to administrators, programmers, and digital retailers isn’t buying us any more time.
To discuss EHRs is to discuss time.