Physicians must balance EHR functionality with physical exams

The adoption rates of electronic health record systems has been steadily climbing ever since the first stage of meaningful use was incentivized by the Centers for Medicare and Medicaid Services. Though physicians have been vocal in their criticism of the technology at times, this has not stopped doctors from accepting EHR systems as a new and transformative medical tool in their fight to improve quality of care.

However, the degree and ultimate value of this EHR-led transformation has yet to be definitively pinpointed. EHR systems have brought functionality to the medical industry – physicians can check medical records from other hospitals to make sure that medications do not interfere with patients' health – but according to several industry experts, they have also impacted the average physician's ability to perform a physical examination.

EHR systems grow popular
Regardless of their impact on the medical industry, there is no doubt that EHR systems are here to stay. According to a report from the U.S. Centers for Disease Control and Prevention, physicians based in offices have dramatically increased their use of EHR systems since 2007. In that year, usage rates barely topped 35 percent. However, in 2013, office-based physicians adopted EHR systems at a 78 percent clip.

Esther Hing, lead statistician on the CDC report, told VentureBeat that the incentive programs instituted by the CMS deserve all the credit for the surging numbers.

"We think that incentives worked," Hing told the news source. "There's certainly a lot of interest in adopting the EHR, especially among primary care physicians. We can see the number of primary care doctors using the EHR starting to increase in 2010."

Evaluating change
While incentive programs may deserve praise for their part in increase EHR usage, they may also attract blame for the way in which physicians have begun to use the technology irrespective of best practices.

Speaking to Healthcare IT News, Abraham Verghese, M.D., senior associate chairman of the theory and practice of medicine at Stanford University, explained that more and more physicians are losing skills vital to identifying conditions during a physical examination of patients – once a fundamental ability.

"There are two reasons it remains crucial to [perform physical examinations] at least as well as doctors did 100 years ago," Verghese told the news source. "We can pick off the low-hanging fruit – the obvious diagnosis that one can miss at great cost to the patient."

These easily identifiable conditions include enlarged lymph nodes, mobility issues or physical palpations for cancerous growths. Veghese also said that physical examinations still loom large in patients minds as a way to establish trust and good faith between both parties.

However, the prevalence of technology in today's health care industry has altered the way the physicians perform their medical duties. Verghese explained that poorly developed EHR systems and overzealous federal regulations can place so many demands on physicians to abide by and input data into electronic systems that physical examinations have taken a backseat to delivering effective care by any means.

"If you come to our hospital missing a finger, no one will believe you until we get a CT scan, an MRI and an orthopedic consult," Verghese said.

EHR systems hold the potential to be a revolutionizing force in health care, but physicians must keep their priorities straight. Prompt and accurate care is the end goal in all situations. EHR systems as well as physical examinations are only tools physicians can use to arrive at that destination, though it is up to each doctor to determine when to use which.