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Electronic Records Limit Docs' Contact with Patients, Panel Is Told

By Melanie Zanona, CQ Roll Call

June 16, 2015 -- Although electronic health records (EHRs) can improve the quality of care, some health experts warn that overly burdensome documentation requirements are forcing doctors to spend more time on computers at the expense of interacting with their patients.

"Complaints of increased time burdens on the practitioner, loss of provider interactions with patients and frustration with new requirements and changed workflows dominated discussion among providers, even as the capability of EHR's to reduce errors and improve communication had grown," said Boyd Vindell Washington, president of Unified Medical Group and chief medical information officer of Franciscan Missionaries of Our Lady Health System, told the Senate Health, Education, Labor, and Pensions Committee last week.

The Senate panel is holding a series of hearings to explore ways to improve a $30 billion federal program meant to encourage the adoption of electronic health records. The 2009 stimulus package (PL 111-5) created the Meaningful Use Program to incentivize doctors and hospitals to use electronic medical records. But physicians have struggled to meet the first two phases of requirements. The final rule for the next stage is expected this fall.

One of the major concerns identified in last week's hearing is that existing documentation requirements for quality and billing information are overly burdensome and time-consuming for doctors, which can make the recording requirements more like a "glorified progress note," said Meryl Moss, chief operating officer of Coastal Medical in Providence, R.I.

"They're working well into the evening," said Moss. "What we found is that the record itself drove all the work to them."

Panelists said the current documentation requirements are modeled after the old paper system, such as a requirement that physicians check boxes to demonstrate providers reviewed data or performed tests. They said the rules can be redundant and unnecessary.

Such requirements "place unnecessary burdens on providers and do not substantially improve the care," Washington said. "As the industry switches from volume to value, the importance of documentation as a check and balance should lessen and providers should be rewarded more for expected outcomes."

Some of the recommendations to address the problem include streamlining the documentation requirements, adjusting the standards to be more consistent with the electronic world and allowing certain information to be entered by someone other than the doctor, such as a nurse or an aide.

Bill Cassidy, a physician who chaired the hearing, also said doctors spend too much time focusing on medical records as opposed to interacting with their patients. The Louisiana Republican pointed to how doctors determine whether a patient has received an appendectomy, saying younger doctors are more likely to just rely on what a medical record says while older doctors are more likely to look for a physical scar on the individual.

"As a physician, time is better spent looking into a patient's eyes . . . as opposed to clicking through a computer screen to document something unimportant to her and required by someone far removed from the exam room," Cassidy said.

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