Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era
This follow-on article moves the discussion forward by adding further dimension to the issue of unintended consequences from the perspective of the United States health system.
Unintended Consequence 4: Physician Burnout
The Path Forward
In addition to simplifying billing requirements and developing informatics solutions to extract quality indicators from clinical documentation, a fundamental redesign of the EHR to improve data entry and retrieval is needed. The structured and static format of current EHR interfaces force physicians to record clinical data through predefined and strict functionality dependent on the current desktop kit (pointer + keyboard + monitor with a cluttered EHR interface). For physicians to keep the richer narrative of their clinical assessments while decreasing the documentation burden, EHRs must demand less typing and clicking. New technologies such as conversational speech recognition (CSR) have recently achieved human parity with regards to transcription error rate and have tremendous potential for substantially decreasing typing and clicking. However, CSR solutions may be compromised by the fact that clinicians may make conscious decisions about what information to communicate to patients and to document in the EHR. Therefore, there are opportunities for research exploring what information clinicians document (or not) in the EHR and what information they do not communicate verbally to the patient but document in their clinical notes; such findings will inform development of CSR and other data-entry solutions capable of handling such situations. Regarding data retrieval, EHR content retrieved by physicians is influenced by their tasks or information goals; however, such stimuli are not captured by current EHRs. Future research should investigate how EHRs can support data retrieval with intelligent stimulus- or goal-oriented functionality that allows a holistic view of the patient and flexible navigation across the record to hopefully decrease the documentation burden and its contribution to the next UC: data obfuscation.