Electronic health records: A hard pill to swallow for some doctors

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MINNEAPOLIS — Justine Mrosak entered the exam room, laptop in hand, and began interviewing her patient about his shoulder injury, systematically checking off questions and entering medical data on the computer.

At Entira Family Clinics, where the third-year medical student was making her rounds, the computer has become an extension of the doctor's arm, as essential to patient care as the stethoscope.

Dr. Cindy Firkins Smith sees things a bit differently. The Willmar, Minn., dermatologist hates to put technology between her patient and herself, and finds data entry a time-consuming chore.

"You are taking the most expensive cog in the wheel," she said, "and you are making them a computer input person."

Electronic health records are supposed to represent the next great leap in medicine -- reducing medical errors and enhancing the physician's diagnostic powers. A 2007 state statute requires all Minnesota health care providers to adopt them by 2015, and the 2010 Affordable Care Act includes a host of incentives for their adoption.

Yet, health professionals have mixed feelings about the digital records even though they are now in place at scores of Minnesota clinics and most Minnesota hospitals. Some praise them as a teaching and diagnostic tool, while others say they clutter up the patient-doctor relationship.

When Smith goes into the exam room to see her patients in Willmar, she leaves the tablet computer in her office. She wants to maintain the connection with her patient, she said, and putting technology between them prevents that.

So Smith prints out everything she needs and takes notes on paper, keeping eye contact with her patients.

When she's done seeing patients for the day, Smith transfers her notes into the electronic system. It adds hours to her day, she said, and reduces the number of patients she can see.

One advantage, she said, is that she can easily read records from home, which allows her to finish some data entry after work. At other times, however, it just seems to make her day longer. During a recent workday, Smith finished seeing patients at 11:30 a.m. but did computer work until 2 p.m.

Electronic records give patients more control over their health care, said Bonnie Westra, a registered nurse, worked in the electronic records industry for 12 years before becoming an associate professor at the University of Minnesota.

"It (allows) patients to more fully participate in their care," she said.

On a recent morning at the Entira Family Clinic in White Bear Lake, Mrosak was seeing James Andrea, who was in for an arm and shoulder injury. She went through the questions laid out by the electronic health record, checking family health history and medications. But whenever Andrea started talking, Mrosak turned her attention from the computer and listened.

Dr. Dave Thorson, the physician who was supervising Mrosak that day, said he and his colleagues prefer their clinic's electronic records over paper charts, and surveys have shown his patients like them, too.

But for physicians who haven't mastered the art of managing the digital record while giving the patient enough attention, he said, it can be difficult.