Yes, that probably feels like a clickbait headline, but it was what one reader asserted in the comments of my article that Paper Is Contagious. You can check out the full comment here. This is definitely something I’ve heard before this comment. In fact, I’ve heard it a lot. However, if we’ve learned anything in the last few years, it’s that just because you hear something a lot doesn’t make it true. In this case, I think there’s a lot more nuance than most people want to consider. This is how I look at it.
Do doctors almost universally hate EHRs? Or do they just universally hate the documentation part of their job and the explosion of documentation requirements that their job has put on them?
Doctors universally hated paper charts too. That’s why stacks of paper charts would be seen on doctors’ desks. They didn’t want to do the paper chart documentation either. They also hated searching for paper charts and hated reading their colleagues (and sometimes their own) terrible handwriting. Although, we don’t hear those complaints from EHR users since the EHR literally solves those problem. The challenge is that doctors just take those for granted now.
Don’t get me wrong. There’s a lot more EHR vendors can do to make EHR software better for doctors, but I think much of the ire around EHR software is a reflection of the reimbursement and regulatory documentation requirements and not the EHR itself.
In fact, if you think about other industries, does anyone like the documentation part of their job? Salespeople hate filling out their travel forms to get reimbursed for their travels. Lawyers hate all the documentation they have to complete as part of a lawsuit. Programmers hate adding notes to their code to explain how the code works. Accountants hate having to reconcile…ok…maybe that’s a bad example, but you get the point. No one likes the tedious, documentation parts of their job. Why should doctors like it any more than others?
Is the real problem here the EHR, or is it the explosion of documentation that’s now required of doctors to get paid (something they presumably want to continue doing) and meet other regulatory requirements? I’d argue it’s the later and that EHR vendors are a reflection of this growing documentation burden.
My point here is that it’s much more complex than most people realize and than most people who experienced paper charts remember. It’s normal now that we’re in the world of EHRs (and not going back) to romanticize how good paper was, but it’s easy (maybe even natural) to remember the good and forget the bad.
Should we just accept this fate and tell doctors to stop complaining? Of course not. The documentation is brutal and is so cumbersome that I’m sure it’s impacting care in negative ways. We should do everything we can to decrease the documentation burden on doctors so they can spend more time using all that training to help patients. However, in my opinion, blaming the EHR is counterproductive to this goal if the real problem is the reimbursement and regulator documentation requirements. Let’s place physician complaints and ire where the problem actually lies.
For those familiar with reimbursement and regulations, you know that simplifying this isn’t an easy path either. Is there hope that technology can help this situation as well? I believe so and it’s why I’m so excited about the quickly developing ambient clinical voice technology. Could it remove some of this burden? I believe it will even if it’s not perfect yet and make take years to fully bake.
When you think about it, the ideal doctor workflow is that they walk into the exam room, they see the patient, they care for the patient, and then when they walk out of the exam room and the documentation has been done for them. That’s the ideal doctor workflow. Ambient clinical voice is working towards that workflow.
The automated documentation may take review by the doctor after the fact, but ambient clinical voice is getting us much closer to removing the documentation burden from the physician. Plus, it satisfies all the regulatory and reimbursement requirements along with the granular data that will be needed for future clinical decision support and other areas like it.
Even more exciting is that the right AI layer could create different views like the narrative note that doctors would really like to see vs a billing view that would be helpful to the biller and so forth. Is it there yet? No. Are they making great progress? Yes.
I’d love to hear your thoughts. What else is missing from this conversation? What do you think of the promise of ambient clinical voice? Looking forward to learning from you in the comments and on Twitter with @hcittoday.
