Lolita Alkureishi, MD
Geneia Joy of Medicine Challenge Finalist
EHR of the Future Award Winner
The EHR. It’s an inextricable part of modern medicine. It has great potential for organizing information, coordinating care and facilitating health care and quality improvement research. And, oh yeah, it can be a major pain in the backside.
When my clinic went live with our EHR, I trained for a month as a “super user” to help ease the transition. During roll out all my clinics were cancelled, my service time deferred. My only duty that month was to help my colleagues as they desperately searched for buttons amongst endless menus. I was tech support.
It was a strange month.
Tech savvy folks (mostly young attendings) were getting up to speed pretty quickly. They were excited about creating quick text and finding shortcuts. They were catching on to the logistics of use fast.
The others (mostly the older attendings who never encountered an EHR before) were fumbling. They were frantic at times, angry at the computer and the world in general. Threats of retirement were made. It was not fun.
Patients were understanding for the most part. I heard them say the delays weren’t the doctors’ fault. That it’d get better, it’d be like before but just with this new desktop in the room.
But would it?
After the first two weeks, things settled a bit. People began remembering their passwords and how to pull up their schedules. I was getting less heated threats hurled my way. Things looked brighter. Or so I thought.
It was in these next two weeks, as the dust settled, that I saw the most worrisome behavior developing. It was bad. It was scary.
What I saw was attendings (and residents) focusing more on the computer than their patient. And it wasn’t because they didn’t have the hang of using it; they were actually pretty good at that point. They were instead choosing to give the computer more attention than the patient, and it didn’t feel right.
Some of the rooms were ergonomic nightmares creating scenes where sometimes providers had their backs to the patient. They weren’t even turning around! No screen sharing with patients. And lots. And lots. Of. Silence. Punctuated. By templated. Computer. Led. Questioning.
It was like this thing was not only taking time and attention away, it was changing the content of the actual conversation. There was a new party in the room, and by the looks of it, it was running the show.
Like many of us in medicine, I chose to go into primary care because I love developing longitudinal relationships with my patients and their families. Well child checkups are more like reunions with old friends. I seek that conversation, that chance to catch up with my families, and with the introduction of the EHR, I quickly saw that relationship was changing. What was going on?
Like those late night infomercials—we’ve all seen them—I knew there HAD to be a better way! My internal medicine colleagues Wei Wei Lee, Jeanne Farnan and Vinny Arora all felt similarly, and together we secured funding from several sources including the University of Chicago Academy of Distinguished Medical Educators, the Gold Foundation and the Bucksbaum Institute for Clinical Excellence to figure out what that better way would be.
As a result of our literature search, we found nearly 75% of patients noted NO change in their overall satisfaction, perception of their patient-doctor relationship or communication as a result of the computer being introduced into the clinical encounter. No change.
While some may claim that’s a good thing, we felt like it was a huge missed opportunity. Why not use this technology for good and not evil? Take advantage of its power to educate patients, to engage them in their care, to facilitate further dialogue! Implement best practices on key communication behaviors to do this the right way!
We’ve since published a curriculum on how to use the EHR in a more patient-centered manner and we’re fighting the good fight by disseminating it to our captive audience (medical students and residents) as part of their required training, but where we really want to spread the word is within our colleague network.
That’s what made participating in the Geneia Joy of Medicine Challenge so exciting! It was a way to network with like-minded professionals to talk about how we can start thinking about the EHR and patient-care. A chance to envision what EHR 2.0 can look like—beyond something dictated by billing requirements—and instead something that is not only more user-friendly for us but patient-centered as well.
I’m hopeful, certainly more hopeful than I was at the start of this EHR journey that together we can advocate for systems that work for us and for our patients. That we can all learn how to use those systems better. That we have a chance to get back to patient-centered care, with the added bonus of the computer and everything it has to offer.
That’s a fight worth fighting, and this forum has been a fun and exciting way to raise the battle cry. I’m looking forward to seeing what comes next. EHR version 2.0 get ready because there are going to be some changes coming.