“The real key is to understand that the electronic health record in whatever format it takes is a tool, like a pencil or a typewriter or a hammer is a tool,” Dr. Doyle said. “People have tended to focus on the fact it is an electronic record instead of the fact it is a clinical record. It is a tool to help us do clinical work. It is not a billing tool and it’s not for quality management, either. Part of why they do not improve patient safety is that they were not designed to do that.”
Dr. Moore, though, sees that tool improving care even if it only provides more accurate, legible records when compared to hand-written records.
“My experience is that when EHRs are used well, there is reason to think that it can actually be something that allows anesthesiologists to provide better care than when they are just documenting on paper,” he said. “There are optimal ways to use electronic records systems. One of the ways is to make sure the output for the final record has the critical information easily viewable in a way that makes sense.”
The benefits of well-designed EHRs are even greater, though, Dr. Moore said.
“First, they minimize the distraction of patient care during the busy, complex, rapidly changing environment of anesthesia care, especially in the operating room,” he said of EHRs. “Second, a well-designed EHR anesthesia information management system can provide records from a previous anesthetic that informs an anesthesiologist well for an upcoming anesthetic to make good decisions and manage patients optimally in ways that on paper are hard to achieve.”
A major problem with EHRs, Dr. Doyle said, is that no standards have been established.
“At no point in any of the meaningful use discussions or implementation, until the last six months, was there what I think should have been the appropriate focus on interoperability or plug-and-play,” she said. “We kind of put the cart before horse when we did not develop any standards up front. Standards can be as simple as how do you represent height and weight – it is lack of consistency in nomenclature that is a problem.”