The Painful EHR Transition

For the past 6 weeks I and the several hundred other ambulatory  physicians who belong to the St. Luke’s Medical Group have been going through a difficult transition; we’ve changed the software that we use to manage patient information.
Seven years ago we made the painful transition from paper patient charts to an electronic health record (EHR) called eClinical Works. This process required lots of scanning but by 2015 when i wrote “I Absolutely Love and Abhor My EMR” I had become very facile and comfortable with the software.
During this current transition to an EHR called Cerner,  we had to drastically reduce the number of patients seen per day in the office as we learned how to streamline workflow and as bugs were worked out of the system. We have struggled mightily with the simplest of tasks such as renewing patient prescriptions, scheduling tests, or reviewing test results. Stress levels for everyone, assistants to physicians, went through the roof as we spent hours clicking, refreshing, and re-entering data ion our frequently crashing computers.
My apologies to all the patients that had to be rescheduled during this process and to any who had to wait excessively for something as simple as a follow up appointment. The bugs aren’t completely out but we are making progress.
And my apologies to readers of the skeptical cardiologist as this EHR transition plus other work and social demands have left me no time to write.
Atul Gawande, a surgeon and excellent writer has written a great piece for the New Yorker entitled “The Upgrade: Why doctors hate their computers.” which nicely details why doctors have reached a point where they  “actively, viscerally, volubly hate their computers.”
Prior to our Cerner transition I was in a good relationship with my various Mac laptops but for the last 6 weeks interacting with the EHR has made me a stressed, anxious and borderline depressed physician.
I am only 6 weeks into the new EHR but Gawande, who has been using Epic* since 2015 writes that “I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me.”
“A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient-whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. These tasks spill over after hours and the result has been epidemic levels of burnout among clinicians.”
The first 6 months of any EHR transition are by far the most difficult as all users gain proficiency with the workflow and as most patients are newly entering the system.  Hopefully, 6 months from now the computer will not be my master and I and my staff will not be burned out.
Skeptically Yours,
*Epic is the most widely used EHR by ambulatory physicians. Gawande makes the claim that “more than half of Americans have their health information in the Epic system. ” This graph indicates Epic is definitely the market leader but seems to have less than 50% of patients.
On the other hand, this recent report indicates that ” Cerner leads the worldwide EHR market with Epic taking the second spot, Allscripts in third and GE Healthcare at fourth.”


7 thoughts on “The Painful EHR Transition”

  1. For more than two weeks, staff for our St. Luke’s PCP was unable to print out a fax for us to review….and the Cerner “trainer” who was right there when I first called was also unable to figure it out! All faxes now go to a central system, and not to the doctor’s office. Supposedly, this is so information can be stored in the patient’s EHR and viewed by all medical staff….but in electronic format only! The system is not designed to make it easy to provide any information to the patient, of course. It is utterly ridiculous….hardly what anyone would consider progress.

    • Hopefully this will improve. One improvement will be that whereas previously for each practice at St. Luke’s you needed a separate account moving forward you should just have one log in that will allow you to see labs and test results from all your physicians.
      I’m a patient myself and will be testing this out soon.

  2. My wife had surgery at St Luke’s St Louis on October 16. It has been a terribly difficult time contacting the doctor’s office. FAXes may go nowhere, voicemail takes days to get replies. Each nurse sees different things on my wife’s chart, depending on which class they have taken for the “enhanced” system. Signs are everywhere in the hospital saying “Please be patient with us as we transition to an enhanced system to serve you better.”

  3. Not only has the new software adversely affected physicians at your hospital, it has also adversely affected patients. Under the old system the patient could view lab test results for many years, and physician reports were also available. No more. Lab tests before some date in 2017 are gone as are physician reports. It would have been nice if the hospital had hinted to patients before the transition that this might happen, so patients could have downloaded and saved that information from the old system.

  4. They installed Cerner in my province PEI, Canada. The software has been a decade long process of learning and mods. It cost 10 x the original estimate and there are many pieces not connected. Blame is shared by the hospital which insisted on changes and Cerner who bill for every paper clip, metaphorically.
    I saw the Cerner screens two weeks ago after a small surgery. They look like something from Windows 95. I was underwhelmed. The nurses seemed to spend their time trying to find the information they wanted on very busy screens, only redeemed by some color coding of fields.
    The ER doctors love it though since they can dictate everything into e-charts.
    The sales teams for this level of software lean heavily on the pitch they are they “leader” in their field.

    • I hesitate to think about how much this transition to Cerner has cost my hospital/medical group. Gawande said his system’s Cerner transition cost 1.6 billion dollars. I know that there were still Cerner consultants in my office as of yesterday that somebody is paying for.
      The screens are a bewildering mass of tabs and buttons. Tiny little carrots buried in an unexpected corner of the screen turn out to be hugely important.


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