June 2024 President’s Message

Loss of EHR challenging but also has silver linings

by Howard Chang, MD —

When I first started in medicine, all patient documentation was handwritten on paper with a sheet of carbon paper backing. Nowadays, with electronic health records, not nearly as much handwriting happens, so imagine my struggle when the EHR went down. That’s right, my poor, coddled hand muscles cramped up while attempting to write a patient chart. I am fairly certain I was on the brink of hand compartment syndrome!

Joking aside, losing or having limited EHR function is a major challenge that can have serious ramifications, including patient-safety concerns. But healthcare professionals today are exceedingly adaptable, as we have all been forged in the fires of COVID. I’ve also realized there are silver linings in reverting to good ol’ paper charting.

No more Big Brother

As an emergency medicine medical director, one of my jobs is to ensure operational efficiency. Some of the metrics I monitor include door-to-discharge times, order-to-lab collection times, order-to-CT completion times, hospital boarding hours, and the percentage of patients who leave against medical advice. I even track the time it takes for physicians to click their name onto the EHR flowboard to confirm patients are signed up as quickly as possible (“door-to-clicky time”). Without an EHR, Big Brother can no longer watch.

One of the major causes of physician burnout is “over-metricization.” I’m not sure if that’s a word, but it’s a term used often in healthcare today. I am certain, though, that physicians are grateful for a break from the constant tracking. They get to practice real bedside medicine without stressing over how quickly they click a button on the computer.

If they need to spend more time with a sick patient and can’t quite make it back to their computer to click on the order set, that’s OK. If they need to use the restroom and let someone else pick up the next patient, that’s OK, too. We are all healthcare professionals, with the key word being “professionals.” We also are some of the most resilient human beings out there, so if physicians are burning out due to over-metricization, then we have a huge problem.

Collaboration with nurses

With the EHR, I could simply click a button and order a medication. Well, it’s actually probably closer to clicking 17 buttons. Regardless, ever since the rollout of the EHR, communication between physicians and nurses has deteriorated. Does this affect patient care? Absolutely.

Without an EHR, we have to physically find a patient chart, then write the order. Next, we have to physically locate the busy nurse and explain our new orders. There are no more magic ordering buttons. We are forced to break down silos and collaborate side by side as a team to ensure high-quality patient care. Whether you’re looking for patient labs, a sputum sample or a set of vitals, you must find your nurse.

The loss of the EHR has made the job of nurses even more difficult, especially medication management. But it also has provided a much-needed reminder to me and other physicians of just how much would not get done without our amazing nurses.

Focus on direct patient care

The Journal of the American Medical Association has a long-running series called “A Piece of My Mind” that explores the joys, challenges and hidden truths of medicine in the modern era. In the June 2012 excerpt, a physician sent in a photo drawn by her 7-year-old patient.

You can see the artist sitting on the doctor’s examination table with her family to the right. But in this picture, the young child portrays her pediatrician hunched over a computer typing away with her back to the patient and family. Is this really how the public views the patient-physician relationship? If so, this would be a huge tragedy, and I believe we must change. We have to rely less on computers and more on the patient relationship.

Data overload

When the EHR goes down, it may be time for your institution to get creative. Dust off those old paper charts and ordering forms. Remind your staff and yourself of what exactly needs to be documented. Nowadays, with the EHR, we are data overloaded. We have pages and pages of numbers, metrics and charts at our fingertips, but really not that much useful information. I can find the time my patient urinated in the morning but not his most recent discharge summary. We have to scroll and click through a mountain of data to find the information we need. With paper charting, we only create the necessary documents needed for patient care. This simplification can lead to more effective decision-making processes, as clinicians are not bombarded with extraneous data. They can prioritize immediate patient needs and make more timely and accurate clinical decisions. Sometimes less is more.

Innovation

We are entering a future where artificial intelligence is becoming the norm. If your EHR ever goes down, use that time to trial innovative solutions like AI charting, HIPAA-compliant text-based communication between clinical teams, or electronic dictation software.

Conclusion

If your EHR hypothetically ever goes down, it will be difficult but don’t panic. You will still take excellent care of your patients, work more collaboratively with your nursing staff, and focus less on the screens and more on the patient. Use this time to test innovative solutions that could turn this negative into a positive. And, lastly, enjoy the benefits of having nice, beefy writing hands.