Enhancing decision support, easing documentation, avoiding errors
It’s time the EMR became the physician’s colleague rather than merely a burden or even an enemy! There’s an additional “clinician” in many medical office visits now – the laptop or tablet housing the electronic medical record (EMR). Described by Austin Frakt as “Your new medical team: algorithms and physicians” (New York Times, 12/7/2015) the potential benefits of computers to enhance medical care are finally being realized. Though the value of the “human factor” – physician touch, judgement, empathy and personal bond with the patient cannot be understated, increasing adoption and utilization of computer technology is impacting at least three areas of medical practice:
- Analysis of clinical data from large populations to identify previously unrecognized patterns useful in diagnosis and treatment
- Review of the immense and ever-growing medical literature to identify critical studies for best practice recommendations
- The EMR – offering evidence based decision support, enhanced documentation, avoidance of medical errors, and opportunity for ongoing quality improvement.
As a practicing physician for more than 30 years at Cleveland Clinic where an EMR has been used for more than a decade, I’m well aware of the frustration of many clinicians with their new “partner.” Physician productivity and satisfaction may be diminished by increased documentation time generating notes which are compilations of check boxed lists and of little clinical value. Recent studies confirm that more physician eye contact with the keyboard rather than the patient reduces the satisfaction of both. Since few EMRs offer any real clinical decision support during the actual visit, the opportunity to improve practice and reduce inappropriate variation in care is missed.
To realize the potential of the EMR to really function as partner to the physician, we’ve identified several key elements:
- Involvement of physician teams or champions in building an evidence-informed clinical workflow with decision support
- Software design which eases data entry and provides decision support along the pathway
- Automated inclusion of previously obtained historical or patient entered data
- A readable, clinically relevant and useable note
- Improved efficiency by automating order entry when appropriate
- Ongoing support for regular review and revision
Realizing the full promise of the EMR will improve both physician and patient satisfaction while optimizing the value of care.