Electronic health records (EHR) have caused many problems for the patient-physician relationship, and Sen. Bill Cassidy, MD, R-La., definitely has his fair share of troublesome EHR stories. The current state of EHRs is tearing the patient-physician relationship apart, Sen. Cassidy said. And that’s why he is taking steps in the U.S. Senate to relieve this burden and put physicians in the driver's seat.
Sen. Cassidy recently spoke to the health IT community at Health Datapalooza in Washington, D.C.
Sen. Cassidy and Sen. Sheldon Whitehouse, D-R.I., who also spoke at the event, introduced the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, also called the TRUST IT Act, which would create a star rating system to assess the interoperability, usability and security of certified health IT. The AMA issued a letter of support (log in) for this bill.
4 stories: How EHRs are affecting relationships with patients
X-ray on a disc: Sen. Cassidy said his mother recently had an injury, and he accompanied her to her physician’s office. All the required steps in the EHR almost led to the wrong test being ordered and a collapsed vertebra being missed.
In seeking advice from a fellow physician and friend the next day, Sen. Cassidy asked if he could take a look at the x-ray and offer his opinion. The physician said that the two facilities don’t share data and so the senator would have to put the information on a disc and bring it in himself.
“I’m thinking, this is great,” Sen. Cassidy said. “I used to bring films, and now I bring a disc.”
The EHR box: Just two weeks ago, Sen. Cassidy received a call from a resident in his home state of Louisiana, who expressed her growing frustrations with her EHR. “She feels as if she is in a box,” he said. “She can’t do what she went to medical school for because she’s always in the EHR.”
“She feels frustrated because she grew up with [technology],” the he said. “As a physician, but also as the son of a patient … I think what we should most focus on is the patient-physician relationship.”
But EHRs are tearing it apart, he said. “Whatever the promise and whatever the potential …unless we pay attention to that patient-physician relationship, it will all be for naught.”
A recent study tracking resident EHR usage found that residents in a teaching hospital each spent 112 hours per month on 206 patient encounters.
“I think what we want,” Sen. Cassidy said, “is for the physician to have the capability to still focus what he or she needs to do based on that particular patient’s needs—not [be] driven by drop-down boxes.”
Interacting with the EHR, not the patient: When recently visiting a physician friend who said he’s required to have 30-minute visits with each patient at the VA clinic, Sen. Cassidy asked if he really needed that full 30 minutes. “He said, ‘I don’t have time to speak to the patient,’” Sen. Cassidy recalled. “‘I have 30 minutes, but I only have five minutes to actually turn, face the patient and see what his problem is.’”
“When you spend so much time on an EHR,” Sen. Cassidy said, “the issue [is] not that you’re not paid for it …. Rather, it is [that] your time is consumed by your EHR.”
Pulled away from patients: Sen. Cassidy’s wife is a retired breast cancer surgeon. “She said that when a woman came, and she had breast cancer,” he said, “she would speak to the woman—it was usually the husband who was crying—and she would want to look into their eyes to know that the diagnosis of breast cancer was not a sentence to death, but rather it was the next phase of their life and that there was hope and that they would come through this.”
“It was looking into their eyes and reading body language and understanding when to pull back and when to press forward as she gave information that made my wife such an effective clinician,” Sen. Cassidy said. “I can promise you, [you can’t do that] if you’re staring at a drop-down box.”
How the TRUST IT Act can help
“In the TRUST IT Act,” Sen. Cassidy said, “we attempt to establish a new paradigm—measure outcomes not processes.” It doesn’t matter how the patient gets to the best possible outcome, as long as they reach that outcome and their health is improved, he said.
The act would create a grading system of EHR interoperability used by those who participate in the delivery of care. “Ideally,” he said, “the outcome would not be defined by somebody sitting in Washington but by the creativity of [physicians and developers].”
“The focus should be the patient-physician relationship,” Sen. Cassidy said. “We have to start thinking less about what software works for those big institutions, which have every interest in the world in data-blocking, and more as to what works for me, the patient, me, the physician, [and] me, the son of the patient.”
“Although many physicians are discouraged by EHRs,” he said, “Most don’t want to go back …. Physicians are dedicated people.”
The AMA has taken action on EHRs in several ways
- BreakTheRedTape, the AMA’s grassroots effort, held town halls in Seattle, Boston and Atlanta.
- JAMA sponsored an event gathering experts to discuss why EHRs should be a top priority
- The AMA’s STEPS Forward ™ collection of practice transformation initiatives can help you select and purchase EHR products and how to address documentation woes
- Find out eight things physicians said about EHRs in an AMA-RAND study
- The AMA and MedStar evaluated the usability of the top 20 EHR products with a new framework
