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Saturday, July 2, 2016

The problem of patient medical record - Treating records or treating patients?

From Medline Plus on 06/28/16:

TUESDAY, June 28, 2016 (HealthDay News) -- Doctors say they're drowning in electronic paperwork, feeling burned out and dissatisfied with their jobs thanks to countless hours spent filling out computerized medical forms, researchers report.
Electronic health records are a cornerstone in the effort to modernize medicine. But, new systems designed to chart a patient's progress and instruct their future care have proven to be very time-consuming, the study found.
"While some aspects of electronic records can improve efficiency, computerized physician order entry is a major source of inefficiency and clerical burden for physicians," explained lead author Dr. Tait Shanafelt, a Mayo Clinic hematologist and oncologist. "Tasks that used to be accomplished with a verbal or written order in less than 30 seconds can now take more than five minutes."
As a result, physicians using these electronic records reported higher rates of burnout and increased frustration with the amount of computerized paperwork they must do, Shanafelt and his colleagues found.
The survey of more than 6,300 active physicians found self-reported burnout among:
  • About 57 percent of doctors using electronic health records, which serve as a computerized version of a patient's medical history. Only 44 percent of those who didn't use electronic health records feared burnout.
  • Between 56 percent and 59 percent of doctors who use computerized physician order entry (CPOE), an electronic system doctors use to share instructions for patient care. Only 45 percent of doctors not using CPOE suffered from burnout.
The doctors also were more likely to be dissatisfied with their daily amount of clerical work if they used electronic records, the survey revealed.
Patients ultimately are the ones who suffer if doctors are constantly stressed out, Shanafelt said.
"Physician burnout has been linked to decreased quality of care and medical errors, as well as an increase in the likelihood physicians will cut back their work hours or leave the profession," he said.
Dr. Wanda Filer is president of the American Academy of Family Physicians. She said doctors find electronic health records to be a nuisance because the systems often have been designed to help bill insurance, rather than to aid medical care or help doctors manage their workflow.
For example, patients who go to a family doctor often need care for multiple health problems, requiring many different prescriptions, laboratory tests and care recommendations, Filer said.
"The EHR [electronic health record] is often designed for a quick clinical encounter like a head cold and becomes very clunky when you need to document more detailed information," she said.
"Trying to enter and manage vast amounts of clinical data has become incredibly time-consuming, pulling physicians away from their real purpose, which is patient care," Filer explained.
Paper work is a major stressor for behavioral health providers because documenting data regarding patient encounters and patient's situations takes so much time and often the requirements and expectations of different stakeholders are contradictory. The patient record first and foremost should be used as a clinical tool for good patient care, but increasingly, insurance companies, lawyers, regulators, criminal justice, child protective, disability claims evaluators have gotten in on the act. For whom is the clinician keeping the record? How can the information recorded be taken out of context and misconstrued for various purposes?
The advent of electronic health records, EHRs, have only accentuated the problems and potential harms that can be done with a patient record.
As stated in the quoted article above one of the major stressors and job dissatisfiers for health care providers is having to keep and maintain a patient record. These health record requirements directly affect the provider's mental health.
Over 47 years of practice, I have developed some of my own practices in regard to health records that have served me and my patients well. First, I keep very little information in patient records unless there is a clear reason that would serve my patient interests. Otherwise, I do not put anything in the record. This rule of thumb is "less is better," and "when in doubt, leave it out." I have other rules as well which I will share in future articles.

To access the Medline Article, "Doctors swamped by 'E-medicine demands." click here.

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