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Death by 1000 clicks: How do we make EHRs better?

Last year three physicians, John Levinson, Bruce H. Price, and Vikas Sainipublished an op-ed in WBUR that went viral. The piece, “Death by 1000 clicks,” described how electronic health records, once promised as the path to increased efficiency and quality in medicine, have become the “bane of doctors and nurses everywhere.” They called for clinicians, patients, and hospital administrators to come together to solve the problem, and started by holding a WBUR town hall soon after. 

Last month, Dr. Price, chief of the Department of Neurology at McLean hospital, and Dr. Levinson, cardiologist at Massachusetts General Hospital, continued the conversation with a panel called “Death by 1000 clicks: How do we make EHRs better?” at the MGH Center for Law, Brain, and Behavior. Other panelists included Dr. Warner Slack, professor of medicine at Harvard Medical School; Dr. Adrian Gropper, CTO of Patient Privacy Rights; and Dr. James Holsapple, Chair of the Department of Neurosurgery at the Boston Medical Center. Carey Golberg, host of the WBUR CommonHealth blog, moderated the panel. 

Boston Society of Neurology & Psychiatry 2-22-18 from Center for Law, Brain & Behavior on Vimeo.

Dr. Holsapple and Dr. Levinson gave some examples from the field of how EHRs have impacted their practice. Taking notes during rounds used to be a learning experience for junior physicians, said Holsapple, but now doctors have to do rounds, try to remember everything, then spend hours turning them into documentation on the computer. 

“We have turned medical record-keeping from a thinking step into an odious task,” said Holsapple.

Both doctors pointed out that modern EHRs are not only time-consuming to document, but much longer and more difficult to understand. What used to be one page of notes now takes up ten computer screens and is full of cut-and-pasted information. “The clinical needle is buried in a billing haystack,” said Levinson. 

However, EMRs weren’t always this infuriating. Dr. Slack, who was on the front lines of medical computing, explained that early EMRs were an innovative counter to a paternalistic medical culture. They wanted the computer to help patients help themselves and thought the medical record should be shared with the patient. 

“Now use of most clinical computing systems requires more and more time-consuming administrative work with less and less help in return,” said Slack.

“Must we conform to substandard systems? Do we have to accept this?”

Dr. Gropper agreed that patients and physicians should own the EHR, not institutions. He advocated for a patient-centered record system that would be open-source and accessible to providers and family members, not just clinicians inside a specific hospital system.

To get there, we need patient support communities to get involved, sponsors to fund research, and physicians to be early adopters of new EHR systems, said Gropper.

Price posed the question, “Must we conform to substandard systems? Do we have to accept this?” We do not, the panelists asserted. But we have to organize together and stop putting institutions and industry above patients.

“If we – practicing doctors – don’t look for solutions, others will find the solutions for us,” said Levinson, “And they’ll be worse than the system we have now.”

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