The EHR Struggle is Real, But Is Not Without Remedy

This article comes from Todd Stewart, MD, VP of Clinical Integrated Solutions with Mercy Technology Services.

Incorporating electronic health records (EHR) into the actual practice of medicine is a struggle for many physicians. As a physician myself, I think it's because it requires us to do things differently. It sounds simple, but it's not. It takes a great deal of effort and it can lead to provider burn-out, ultimately driving some physicians to leave practice.

The crux of the problem is, with most EHRs, the computer becomes the center of the universe, and that's not what practicing medicine is about. For medical care providers, the patient is always the focus. It's the doctor-patient interaction that matters – everything from eye contact to heart-to-heart conversations about the patient's condition. In essence, the doctor-patient exam should never be with the doctor's back to the patient and eyes glued to a computer screen.

On the flip side, computers as care tools have many advantages. But to make it work, we need to re-engineer the EHR workflow process so physicians can reduce their time spent documenting details that could be done just as well (or better) by someone else.

At Mercy, the fifth largest Catholic health care system based in St. Louis, Mo., we've been experimenting with workflows and improving how we use our Epic EHR. We've created a new position in our clinics called the Care Team Coordinator (CTC). This is a nurse or medical assistant trained to assist clinicians by taking and documenting a patient's history when they arrive. Then, that information is relayed to the clinician just outside the exam room. With the proper CTC training and workflows built into the EHR, this can require as little as two to three minutes.

While in the exam room, the doctor focuses on talking with and examining the patient while the CTC focuses on the EHR. This newly re-engineered workflow allows me to use my medical expertise to provide the best care possible – free of mouse clicks. Then after the CTC enters my orders and I finish the exam, I review the orders. In surveying patients, we have found patients prefer this physician-focused method. And it's no wonder. Not only do patients get better care, but I can see more patients every day, my EHR documentation improves and orders are more accurate and timely.

At Mercy, we continue to experiment with these advanced clinical workflows. Our success over the years in re-engineering and re-programming workflows in Epic to better serve our patients, improve care and reduce costs has garnered awards and earned Epic's seal of approval.  Last year, we became the nation's first provider to be Epic-accredited, so we can help others still struggling with EHR headaches.

While it requires commitment and a good dose of perseverance, the EHR is an effective tool in providing the best patient care with one caveat – the patient is always our central focus.