Electronic Health Records: a “Quadruple Win,” a “Quadruple Failure,” or Simply Time for a Reboot?

Michael Hochman | Journal of General Internal Medicine | February 5, 2018
Michael Hochman

The reality over the ensuring years has, to put it mildly, not met expectations. According to a 2014 analysis led by the Office of the National Coordinator for Health Information,2 over 80% of US doctors now use EHRs. Yet, many of the predictions about the benefits of EHRs have yet to materialize to the extent predicted. Though EHRs have facilitated some substantial improvements—the ability for clinicians to access charts from any wired location, electronic transmission of prescriptions, and enhanced tracking of population health measures, to name just a few—they have also resulted in numerous unintended consequences. Noteworthy concerns include egregious medical errors resulting from design glitches3, charting templates filled extensively with meaningless boilerplate, the common practice of pasting old notes4 that makes it difficult to know which documentation is “real,” “alert fatigue”5 due to excessive EHR warnings, and even reduced communication among clinical team members.6

Moreover, contrary to expectations, EHRs may also hamper clinician productivity—the so-called IT productivity paradox.7 As Robert Wachter, MD, explains in his incisive 2015 book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicines Computer Age,8 many simple tasks like ordering a medication that took seconds using pen and paper can take much longer with computers. EHRs also substantially increase the time it takes for clinicians to document patient encounters,9 and as a result, many health systems report that clinicians see fewer patients per day than they did with paper charts. Furthermore, expectations that EHRs would eliminate wasteful, duplicative services by facilitating health information exchange have, to date, proven illusory in most settings.10 Initial predictions that EHRs would save the healthcare system billions now seem fanciful...