Would I be project manager for the Department of Health (DOH) to implement a national electronic health record (EHR) for all government hospitals?  Not by a long shot. Nonetheless, the task was assigned as coursework for #MI227, Clinical and Laboratory Information Systems.

Top three barriers I discuss here  are what I think would affect me as a physician.  (1) Time:  Time to convert existing patient records and making it interconnect with the new EHR system, (2) Technical: Lack of customisability of EHR to conform to specific needs of a subspecialty, and (3) Social: Interference with doctor-patient relationship.

While learning a new EHR system represent a barrier in itself, I have yet to see how the “old charts” that comprise one’s clinical history can be integrated with full interconnectivity and readability with a new EHR system.  Often, what is resorted to is just scanning of these documents and storing them as pdf files.  I find this unacceptable even for my small clinic practice.

The lack of customisability is recognised as a barrier not just by physicians, but nurses as well. (ref)  There are different specialty units in the hospitals.  An EHR for one unit may not be as efficient for another unit.  There needs to be some level of customisability of the EHR.  This however, will make the process more tedious, and more expensive.

“Electronic health records affect the patient–physician eye contact dynamic differently than paper charts.”(ref)  The advent of the EHR in the middle of the physician-patient encounter has brought to fore gaze patterns between physician, patient and the EHR.(ref)  Witnessing how a physician dealt with my father as he filled up an EHR in his clinic, I thought there was lack of eye contact, with the physician looking at the computer tabs more than the patient.   The “story-telling” of a patient’s story was reduced to tick boxes or drop-down menus.  The art of medicine is lost. The encounter seemed cold.

References:

• El Mahalli A.  Adoption and barriers to adoption of electronic health records by nurses in three government hospitals in Eastern Provice, Saudi Arabia.  Perspect Health Inf Manag.2015 Nov 1;12:1f. eCollection 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632875/
• Montague E, Asan O.  Dynamic modeling of patient and physician eye gaze to understand the effect of electronic health records on doctor-patient communication and attention.  2014 Mar;83(3):225-34. doi: 10.1016/j.ijmedinf.2013.11.003. Epub 2013 Nov 28. Accessed February 27, 2016.  http://www.ncbi.nlm.nih.gov/pubmed/24380671