As Doctors Struggle with New Electronic Record Systems, Care Can Suffer



Lisa Solinas stood in patient room 3, explaining the pros and cons of doing a prenatal screening for birth defects and carefully watching the effect of her words on Aubrey Spiker.

Spiker, who is pregnant — at the time 8-weeks along — nodded and was quiet for a moment. Her eyes were contemplative, they were unsure.

The room was silent, except for the sound of computer keys beating like a heart in the corner. While Solinas focused on the patient, a scribe fastidiously recorded the details of the exam on a computer.

It was a delicate exchange — one that could potentially affect the Spikers and their unborn child for the rest of their lives — and it might not have happened the same way had Solinas been the one inputting the data into the computer, the family physician said after the visit in early February.

“A lot of times people will just start to tear up a little bit, you know, and it’s just so subtle, and then they’ll catch themselves, and then they’ll be fine,” said Solinas, the medical director at Santa Paula Hospital and Santa Paula West Clinic in Ventura County. “It’s those little subtle things that can be missed.”

According to recent surveys, more than half of California physicians and clinics have switched to electronic health records to comply with the federal Affordable Care Act — but for many it has not been a smooth process. Implementation problems are, in some cases, hurting patients.

“While vendors are making an effort to make their (electronic health) systems more usable, there’s still a lot of room for improvement,” said Glen Moy, senior program officer at the California Healthcare Foundation.

In addition to technical glitches, there are human ones. Moy, who is studying the rollout of electronic records statewide, estimates that it can take up to two years for doctors to become competent with a computer-based system and return to full productivity.

During those two years, and particularly in the first six months, patients can experience less effective visits, fewer appointment openings and logjams in accessing their data.

“It’s a big undertaking for any organization, because you’re changing so much of how not just that physician but everyone in that hospital or health center or practice works,” he said.

“There are certain things that providers have to figure out, like, ‘How do I document this encounter while seeing a patient?’ Physicians in a typical practice probably have 10 minutes with a patient, so I don’t think there’s an easy answer to that.”

While scribes are becoming more common, they’re an extra expense, so most doctors are doing the inputting themselves, Moy said.

According to a report the Healthcare Foundation released in November, which compiled survey data from the federal government and private organizations, 77 percent of California adults see electronic health records as a valuable tracking tool.

Physician use of electronic health records has increased steadily over the past five years. In 2008, only 37 percent of doctors used the technology, but by 2012, 59 percent had made the switch, according to the report.

About half of California hospitals used electronic records in 2012. Health centers report the highest use of the technology, with 65 percent using electronic records in 2011.

While Moy estimates the majority of large to mid-sized health systems have started using electronic records, many solo practitioners, those in smaller practices and specialists have not. “They lack the resources to help them with implementation,” he said.

The Affordable Care Act requires health plans to begin using electronic records to streamline billing and improve access to patient data. Care providers must follow suit in order to comply with other aspects of the new law, known as Obamacare.

Electronic systems are designed to help catch errors, screen for potential allergic reactions and improve access to records for both patients and doctors, among other benefits.

Ventura County Medical Center, its 35 clinics and seven urgent-care offices switched to an electronic system in July. For the first two weeks, doctors worked at 50 percent of productivity, seeing only patients with urgent issues. By the fifth week, most clinics had returned to full productivity, but some remained at 80 percent for several weeks after.

While the rate of seeing patients has returned almost to normal, Emem Ekpenyong, a physician assistant at Santa Paula West Clinic, said she still spends nights filling out her electronic charts, because they take longer than the old paper-based system.

These days, eight months after the electronic system was implemented, Ekpenyong often sees patients from 8 a.m. to 8 p.m. and goes home to work on her charts from 8:30 to 11 p.m. “That’s not ideal,” she said. “But at this point I’m not willing to sacrifice that patient encounter.”

Still, she sees the benefit of the technology.

“As much as lot of people still don’t like it, and it is tedious, I look at it from a different point of view,” Ekpenyong said. “In the next year it’ll be better. In the first year, there are going to be some moments where you just say, ‘I want to kill this thing,’ but centralizing patient care is ultimately a good thing.”

Although scribes can be helpful, Moy said he believes the solution is to improve technology so that a computer can effectively act as a scribe, using voice recognition software.

For now, Solinas said she’s thankful she found money in her clinic’s budget for a scribe. Spiker, who heard her baby’s heartbeat for the first time during the February visit, agreed.

“I like that there’s a computer in the room so she can pull up my history,” she said, “But if there hadn’t been a scribe, I think it would have been distracting. There would have been a lot less eye contact and that’s important to me, because these are important decisions we’re making.”

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