In a complicated relationship: Physicians and EHRs!

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Ishan Timilsina
Project & Operations Manager

Healthcare has experienced a significant number of growing pains and challenges in using EHRs. These problems have included technical as well as compliance issues. For example, early EHRs lacked the ability to annotate images or even compare images on the same screen; in the paper-based world, that task required only some desk space and a pen.

The EHR checklists and features offered by vendors were also missing important aspects of patient services and clinical operations. The evaluation and management note standards were programmed into many EHRs to help doctors meet the evaluation and management documentation standards. The EHRs encouraged (or forced) clinicians to fully document information that was not necessarily documented in the paper chart. For example, on paper charts, many physicians documented remarkable findings in detail and negative findings as within normal limits, but some EHRs forced the physician to provide more extensive documentation for unremarkable observations.

Some challenges while transmitting from paper charts to electronic health record(EHR):

  • Paper charts contain important contextual information about the patient’s medical history. In addition, medical and legal standards require keeping historical information from the paper chart. A physician may have an expensive and complex challenge in properly setting up the patient in the EHR and recording clinically important information from the paper chart. For example, a birth abnormality, previous procedure, abnormal lab result, or history of blood test results may be important for specific patients but not easily transferred from the paper chart to the EHR. Indeed, a significant amount of patient information may still be on a paper chart after the EHR is in use, or the practice may be faced with an expensive process to scan the previous paper chart into the EHR.
  • The practice may own old diagnostic equipment that cannot be connected to the EHR. After conversion, the EHR becomes the location of the patient’s designated record. In that case, the practice may have to incur the expense of diagnostic equipment that can work with the EHR, or have to scan and/or enter diagnostic images, readings, and information into the EHR.
  • EHR tools dramatically affect the speed of information movement and the tracking of patient service in the practice. Important roles that exist in the paper world may disappear with an EHR, and jobs that don’t exist in the paper-based office will become essential with an EHR. For example, doctor assistance might not be needed with an EHR, but your practice may need an EHR support specialist.
  • Flipping through a paper chart can easily give you a general impression of the patient. Many physicians can get an excellent overview of the patient’s situation based on the pages documenting the frequency and type of tests, as well as other documents. Flipping through an electronic chart is more time-consuming because each image must be separately accessed.
  • Many physicians document remarkable observations in paper charts that can concisely flag remarkable issues relevant to the patient’s situation. EHRs collect much more data, which may be more difficult to review for the relevant remarkable information. For example, some doctors have encountered a 5 to 10 page office note from an EHR, whereas their previous notes consisted of a few paragraphs of relevant information.

In addition, doctors may have to dramatically change their patient service style to work with the EHR. The checklists in the EHR may differ from how the clinician previously collected information. In other instances, the clinician may have issues with the EHR’s user interface. Any change to the doctor’s treatment style could have ripple effects on patient flow and services. Adopting an EHR requires intense practice so that the physician doesn’t experience a slowdown in productivity and patient services.

Because all information is in the EHR, all staff and doctors need to have constant access to it. Staff and physicians who are not comfortable with or skilled in using an EHR may end up with clinical and operational problems in the practice. And it is important for every practice to have adequate workstations, tablets, and computing power to effectively serve all staff and physicians at the same time.


An EHR brings a variety of benefits. However, a practice needs to overcome a substantial set of challenges to avoid having problems implementing or using an EHR.

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