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In our practice we have developed a team based model of care, where the nurses take an active role in prevention, chronic illness care, care coordination and documentation. We are hampered in our efforts by limitations in our EHR(McKesson) and constraints of policy, both of which are often designed for the old paradigm in which the sole important interaction is between the doctor and the patient, or perhaps more perversely in recent times, the doctor and the computer.
From technology we need 1. a team log-in 2. better longitudinal records 3. improved usability.
From policy makers we need evidenced-based policies around security, signatures and order entry.
For example, my team and I spend several hours each day on wasteful workflows. A task that should be doable on one screen… more »
While each of these may seem individually trivial, they add up to hours of wasted effort each day, increase professional burnout and are a threat to clinical quality. « less
As a family medicine physician who until recently was working for a large hospital system and has experience after going through three electronic health records I can endorse the issues that Ms.Sinsky so aptly puts forth. This problem is common to all enterprise electronic health records at this point in time.
The basic problem is that electronic health records have had two masters-the clinical part of the record which is important for patient care and the billing part of the record. Which one do you think has won out?
The other overriding issue is how physicians and systems are paid. Most systems are still paid on an RVUs/piecemeal basis. The dirty little secret is that electronic health records could be excellent at “not seeing patients” and taking care of populations. By this… more »
Welcome to Planning Room, christine.sinsky. Thank you for your comment. How can the federal government best encourage development of EHRs with improved usability for practices which have developed a team based model of care?