Physician-Friendly Electronic Records Help Docs Go Digital



  • The government offers more than $60,000 in incentives to providers who switch from paper to digital records
  • Doctors who rely mostly on hard data use EHRs more often than those who absorb information through conversations
  • The adoption of EHRs could increase if doctors could collaborate more easily and record  information more freely

In the new science fiction movie “Her,” a man falls in love with his computer.

Among the doctors Holly Lanham studies, that’s not always the case. She’s interested in why they do or don’t click with new technologies — and how that preference affects their adoption of electronic health records.

“There are lots of problems in healthcare with regard to how people, technology and processes fit together,” says Lanham, a former dietician who researches information technology. She serves jointly as an adjunct assistant professor of Information, Risk and Operations Management at the McCombs School of Business, and an assistant professor of medicine at the UT Health Science Center at San Antonio.

Electronic health records, or EHRs, let doctors and hospitals store and report a patient’s medical information digitally. To boosters, they promise more effective and efficient care, along with fewer duplicate tests and medication errors. The Centers for Medicare and Medicaid offer incentives of up to $63,750 to healthcare professionals who switch over from paper and filing cabinets.

Such financial carrots helped double the penetration of EHRs in doctors’ offices over the past three years. Still, most practices have yet to catch on. Only 40 percent have some form of EHR system, according to the most recent survey by the U.S. Department of Health and Human Services.

To encourage more docs to go digital, Lanham looks at ones who already have. “What are the factors,” she asks, “that seem to influence the differences in how physicians incorporate these systems in their work?”

In two recent studies, Lanham looked at eight offices ranging from two to six physicians on staff. She found that, even in this age of high technology, human factors still determine how doctors deploy that technology.

In the first study, she looked at individual physicians and the ways they used information to help make decisions. She found that they fell into three groups:

  • Uncertainty Reducers looked chiefly at hard data, like laboratory results, past medical history and lists of medications and allergies.
  • Uncertainty Absorbers relied more on talk: personal conversations with patients, as well as nurses and other providers.
  • Hybrids used both strategies to manage uncertainty.

Reducers, she found, were heavy users of EHRs. Absorbers used them the least, while Hybrids used them at moderate levels.

How could EHRs be made more useful to the latter two groups? Lanham suggests adding features to pick up information that can’t be captured purely in numbers. Free text fields could be structured to pick up on certain keywords, and to let doctors collaborate, wiki-style, in describing a patient’s condition.

“Narratives and stories are contextual factors that we’re less inclined to capture in an electronic system,” says Lanham. “If we give priority to kinds of information that can be easily captured and overlook other kinds of information, we may not be accomplishing the goal of providing better care.”

A second study examined how physicians communicate with each other within small offices. In practices where they tended to talk and collaborate, doctors also used EHRs in similar ways. “In two of the clinics I studied,” she says, “physicians would meet monthly to talk about questions like, ‘How are we going to modify our templates to accommodate our different styles of practice? Are we all going to agree to enter x-ray information at the same place in the medical record?’”

By contrast, offices with low levels of communication were all over the map on handling EHRs. Recalls Lanham, “One physician was saying, ‘I’m using as many features in this system as I can.’ Next door, the physician was still using paper records. Both physicians were leaders within the organization.”

In such fragmented offices, she says, an information technology manager might need to spend more one-on-one time with each doctor, to make sure EHRs are used consistently throughout the group.

Lanham views both studies as starting points rather than ending points. Her next round will test ways to better design EHRs, to make them useful to a wider array of physicians.

“Not every physician is on board, or recognizes the inevitability or benefits of electronic health records,” says Lanham. “We still have skeptics who see more cons than pros when introducing technology into the patient care process. How do we design systems to recognize and accommodate their differences?”    


Faculty in this Article

Holly Lanham

Visiting Scholar McCombs School of Business

Holly Lanham, Ph.D., MBA, is an assistant professor of medicine at The University of Texas Health Science Center San Antonio and an investigator...

About The Author

Steve Brooks

In a quarter-century as a journalist, Steve Brooks has won two Neal awards for excellence in trade reporting and a Press Club of New Orleans award...

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