Electronic health records continue to cause frustration


Electronic health records are envisioned as a way to streamline medical recordkeeping and make medical records more accurate, and available more quickly and easily to doctors and patients alike.

But now, more than six years after Congress passed the Health Information Technology for Economic and Clinical Health Act of 2009, many view digital health information systems as expensive, inefficient sources of frustration.

It’s possible that the current situation is temporary, caused by the relatively sudden, nationwide transition from paper medical charts to digital medical records. The resulting demand for health information systems has placed a burden on software developers and vendors, and on health care providers who are struggling to adapt to those systems and get them to work properly.

Between 2001 and last fall, the percentage of all physicians who use some type of electronic medical records system rose from 18 percent to 75 percent, according to an October report from the U.S. Department of Health and Human Services.

PVHC conversion difficult

Powell Valley Healthcare began converting to a new electronic medical record system, NextGen, back in 2012. The system was purchased in 2011 under the leadership of former interim PVHC chief executive officer Mike Lieb and implemented under the leadership of his successor, former CEO Bill Patten. Problems were so widespread after the initial implementation in August 2012 that the NextGen system had to be taken offline until it could be improved. A second

“go-live” in January 2013 went somewhat better, but the new EMR system still caused so many problems in so many areas that NextGen finally sent a problem-solving team to help resolve them the following December, nearly a year later.

Patten told the PVHC Board of Directors that one of the biggest challenges for Powell Valley Healthcare’s transition to NextGen was the fact that the organization needs several different health information components to communicate with each other — one for the hospital, another for Powell Valley Clinic, another for Powell Valley Health Care, and still another for the business office.

Josh Baxter, director of information technology at Powell Valley Healthcare, said he came on board at the beginning of the NextGen transition. Ever since then, “it’s been a constant effort to work with the issues,” he said.

But the system is improving, Baxter said.

“We are just incredibly better off than we were two years ago when (the NextGen team members) were here,” Baxter said. “Back then ... we just had constant problems. That’s not the case now.” 

Baxter said NextGen is one of many health information system vendors that have experienced problems developing their systems and getting them to work correctly. Those problems are widespread nationally, he said.

“No perfect vendor exists — they’re like unicorns,” he said.

Still, electronic health records have their advantages.

Baxter said they provide efficiencies that are beneficial, both to patients and to doctors. They improve access to patients’ medical information and history, and they provide immediate and easy-to-access lab and radiology results.

“All that is in a single place where the provider can just go in and access all that patient history,” he said. “The electronic record makes it so, so much better than it used to be with paper.”

But keeping records electronically is different than doing it on paper, and it changes the way doctors interact with their patients, he said.

“EHR changes the way that providers practice medicine, and it’s hard. It’s hard for doctors and nurses to practice medicine in a different way,” Baxter said.

Checking all the required checkboxes on each screen is especially frustrating for doctors and other medical providers. It takes extra time, and doctors often feel the boxes aren’t germane to the patient’s medical situation at the time, Baxter said.

During the Powell Docs Talk forum last fall, doctors expressed frustration about the time it takes to navigate between screens and check all the required boxes.

To reduce doctors’ frustration and the time required, PVHC is considering hiring scribes to take care of electronic recordkeeping during medical appointments, said Terry Odom, interim chief executive officer at Powell Valley Healthcare.

Though frustrating, checking all those boxes is important, as that information is required for a hospital or clinic to demonstrate that it meets federal guidelines for meaningful use of a health information system.

Currently, Powell Valley Healthcare and other health organizations are working to attest to stage two of the guidelines.

Baxter explained the process in general terms.

“It’s a menu that they give to the health care organizations or other providers: These are 15 things you could collect; we require that you collect at least eight of them,” he quoted. “You choose which eight.”

Baxter said those decisions about which data to collect for meaningful use are made with input from doctors and other providers about which information is easiest or most appropriate to collect.

A moving target

The federal government provides financial incentives to providers and hospitals for meeting meaningful use guidelines.

Eventually, however, those incentives will disappear and become penalties instead. Once that happens, doctors and hospitals that do not meet federal meaningful use guidelines will receive lower Medicare and Medicaid reimbursement rates.

“We’re already struggling economically as it is,” Baxter said. “Paying penalties is a very scary thought.”

Adding to those challenges is the fact that federal meaningful use guidelines continue to change; trying to meet them is like aiming at a moving target.

“They’re still talking about what are the options that are going to be for stage three,” Baxter said. “It’s not set in stone yet. They thought it was, but now... It’s not only hard for the providers, but think of the software vendors that have to design” to those guidelines. “When the goalposts change, it’s tough.”

Baxter said he’d like to think that things will settle down and get easier in another five years or so.

“But you know how the government works,” he added. “It never stops.”

To further complicate matters, Powell Valley Healthcare was notified a few months ago that NextGen has sold all but one of its information system components to QuadraMed, another health information services company. The effects of that sale won’t be known for some time, Odom told the PVHC board.

The component that remained with NextGen is the ambulatory component, designed for medical clinics. And that is the component that has been the most problematic for Powell Valley Healthcare, Odom said.

Still, “we’re down the road in our implementation,” she said. “We’re using it, and we’re solving problems more routinely.”