A recent article in the Globe and Mail, included in a Doctors of BC newsflash, led me to write about electronic health records (www.theglobeandmail.com/life/health-and-fitness/health/doctors-using-electronic-records-at-higher-risk-for-burnout-study/article30652673/).
EHR adoption has not included provisions for transcription of pre-existing records/history. EHRs have been a boon for the regional health authorities in British Columbia—gathering of big data to allow further simplification of complex realities and ultimately leading to more homogenization and standardization of our (ideally) complex relationships with real people (patients) on the ground. Bonus incentives for management that are modelled on the corporate sphere make the mining of big data without a thorough understanding of the front-line complexities dangerous. With an agenda to make it easier to have the appearance of accountability and standardization of care, the data are often used to justify reduced real services on the ground and increased micromanagement.
I would hypothesize that in family medicine, burnout leads to a decreased ability to be our patients’ advocates in navigating the idiosyncrasies of nontransparently rationed care, less face time with patients, and more errors, thus justifying a need for more quality assurance and more idiot-proofing built into the EHRs, followed by a need for constant improvements (i.e., not intuitive patches that are usually inconsistent with the original operating platform), and resulting in EHRs that are even more rigid and frustrating. It’s a positive feedback loop and more business for the IT industry. The apparent smartness of drop-down menus and rigid algorithms have reduced flexibility and fit, as well as satisfaction and connection, which are essential in family medicine. Many of us may retire earlier than we otherwise would have, not because we don’t get it and are too rigid to learn, but rather because we do.
—Andre C. Piver, MD
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