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How to ensure EMRs work for physicians and not the other way around :

November 1, 2020

The transition from paper to electronic medical records (EMRs) has fundamentally changed physician workflows and patient care. It also has created burdensome problems for physicians across many practice settings.

One of the major problems of going fully digital is that many administrative tasks have become the physician’s responsibility. Physicians often lament that they are little more than scribes under the tyranny of the notes, and they long for the era when most of the work they did was clinical.

“No physician should feel like their job is a data entry specialist to the EMR,” said Sharief Taraman, M.D., FAAP, clinical informatics diplomate of the American Board of Preventive Medicine and a member of the AAP Council on Clinical Information Technology.

Steps to decrease the administrative burden on physicians include allocating work by role, increasing physician education on EMR use and designing EMRs with the end user in mind.

“There's an opportunity to learn how clinicians use the EMR and then take those learnings and optimize them for usability, and that's not done routinely,” Dr. Taraman said.

Physicians spend years of their lives learning the best way to evaluate a patient, do specific procedures and treat disease. Yet they receive little education or best practice guidelines on how to do the work that now takes up the largest portion of their day — interacting with the EMR.

“We need to self-advocate with things like auto text and macros, but we need to create an educational series in medical school,” Dr. Taraman said.

Additionally, education plans that focus on the end user are necessary to ensure optimal and efficient use. The EMR is a complex tool that requires not only initial training but continued support to leverage new functionalities and to provide feedback about their utility for end users.

Research across the spectrum of industries has shown that standardization improves quality. EMRs are no different; standardization of workflow for EMR users at every level can mitigate administrative overburden.

“How do you prevent inefficiencies in your practice and how do you use this technology to your advantage rather than allowing it to influence you negatively?” Dr. Taraman asked.

Just over the horizon is an array of artificial intelligence technologies that can be leveraged to reduce these inefficiencies. Predictive text, natural language processing, virtual assistant and robotic process automation are technologies we use in other facets of our lives, and their transition to medicine is certain.

The cornerstone of success is clinician engagement. Instead of being resigned to the fact that the EMR has become a disruptive hurdle in their daily workflow, physicians can work to make changes that allow it to be a meaningful tool in the arsenal of care for patients.

“As physicians, we are acutely prone to moral injury because we have a sense of obligation to our patients and health care in general,” Dr. Taraman said. “We have a tendency to keep sacrificing ourselves and taking on more, and we almost have to just demand better.”

Dr. Patel is a member of the AAP Council on Clinical Information Technology.

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