Frontline Account: Physician Partners: An Antidote to the Electronic Health Record.

Abstract

The modern medical record was originally developed in the 1920s as a way for physicians to briefly document patients’ medical conditions and plans for treating them. It was a means of jogging the memory so that solo practitioners could care for thousands of patients and quickly get up to speed on the major issues affecting each. Records were handwritten, lacked a consistent method of organization, and were often illegible to others. As medicine became more complicated and physician groups were formed, it became increasingly important for others to be able to view records, and the structure of the medical note became more standardized. Over time, the medical record began to be used for other purposes, such as for insurers who required documentation to justify reimbursement rates. With the advent of the electronic health record (EHR), the reasons for use have expanded dramatically, including documenting and improving quality of care, scheduling, billing, research, rapid communication within the health system and between patients and physicians, and tracking when and how long physicians are working. In short, the EHR has taken control of physicians’ professional lives. In response, many physicians have become stressed and feel overburdened in practice. To cope with the additional work of documentation, physicians have changed how they interact with the patient, sitting at the keyboard, frequently with eyes on the screen rather than on the patient. They talk less and multitask more, searching for needed information in real time, further eroding the doctor–patient relationship. Some physicians have retired early rather than practice in the new EHR world. Others have off-loaded documentation and other administrative tasks to less highly trained personnel, such as scribes. In 2012, we first heard of these approaches and thought that they might be able to help relieve physician stress locally resulting from a push to see more patients and impending deployment of a new EHR. Accordingly, we built upon existing scribe programs to create the UCLA Physicians Partner program, with the intent of making the physician’s work easier, improving the quality of time spent with patients, and increasing efficiency.