From a professional's perspective, to one of a patient

By Chowning Johnson on May 17th, 2010

As I near the end of my pregnancy, I’m holding down my daytime gig of being a PR/marketing professional in HIT, but I’m also moonlighting as a professional patient. And, at the same time this is happening, the rollout of the ARRA incentives for meaningful EHR use draws closer. We’ve seen the articles lamenting the barriers, others singing the program’s praise and some recently on the impact this will have on vendors and its potential “for bringing measurement, data-based decision-making and accountability to the practice of medicine,” according to Dr. David Blumenthal in a New York Times post.Before starting this pregnancy adventure, I didn’t have an intimate understanding of my providers’ use of technology. Now, almost 40 weeks later and immersed in a myriad of visits, I’ve been granted a peek into the world and opinions of my medical team as I often couldn’t avoid my curiosity about their use of EHRs or lack thereof, and their feelings about ARRA and meaningful use. Do they think that utilizing an EHR in accordance with the terms set forth by meaningful use will bring better measurement and clinical support into their practices? Are they already using a system of some sort on its most basic level? With so many test results and forms needed by OB patients, why isn’t there a PHR used to create greater efficiencies?My primary OB for example, a group of savvy, younger physicians from a variety of backgrounds, has taken a hybrid approach. None of the nurses taking vitals can tell me what EHR they are using, just that it makes entering weight and blood pressure easy. And what about the physicians? After numerous appointments and regularly seeing only paper charts, one OB recently showed up with a tablet PC to my visit. A previous user of a full-fledged EHR at another job, Dr. A—to protect her identity—felt that using an EHR as fully intended was not only cumbersome, but really generated more billings and did not necessarily lead to better clinical care. When using the system and entering all the notes and fields required, the previous EHR still took Dr. A more time to use per patient than traditional charting despite being well beyond the implementation phase. Much happier with the approach she currently uses, my OBGYN practice now uses an EHR to track some basics and have paired it with a document management system for electronic scans of certain paper forms, resulting in a somewhat comprehensive patient view.

Shifting to the search for our pediatrician, one of my primary questions was centered on whether or not an EHR was used in the practice. Yet again, the group we selected ultimately plans to adopt an EHR to avoid penalties, but not any time soon. In searches thus far none of the existing EHRs provide what the group considers to be adequate reporting capabilities or tracking for a pediatric setting.In our world we talk about EHRs saving time and costs, allowing the providers to see more patients and improving clinical care. They most certainly do for some, but not for others it seems. What’s more, despite the technology, the paper-based forms and hard copies of patient charts are abundant. One step at a time is certainly necessary, but what will it take beyond the ARRA incentives and eventual penalties to move physicians to fully implement and use EHRs, make them feel comfortable with the technology and eventually create the efficient, “data-based decision-making” setting we’re striving for? Between these specialty healthcare settings I’ve encountered in my recent experiences, it’s easy to see firsthand the industry adoption issues that we face. Clearly the topic is top of mind in these practices. While we have numerous examples of success stories, I can only imagine there are more practices in situations like mine than adopters out ahead of the curve. What have your experiences been, how does your background impact the way you look at the rapidly changing face of healthcare when you have to play the patient?