I was talking to my sister on the phone the other day. I told her, “You know, even though I’ve been at it all these years, I still get a little spazzed out about going to see patients” – which I now do at the Moss Clinic.
Then I thought about. I corrected myself. “You know it’s not the patients. It’s having to wrestle with the computer. With the electronic medical record.”
An Obligatory “Improvement”
EMR (sometimes called electronic health record or EHR) was introduced in the 60’s and 70’s as the best thing since sliced bread.
There’s no question paper charts are a pain with their illegible/Sanskrit hand writing, the problems of storage, filing, tracking, copying. So, as in so many walks of life, computers have insinuated themselves – encouraged by the American Recovery and Reinvestment Act of 2014, that meant doctors using EMR got paid more – and those who don’t are penalized.
This has been a great business opportunity for developers of EMR – a report in the New England Journal of Medicinenoted more than 700 different vendors and 1750 distinct certified products were in existence already by 2012.
They have cutesy names like Hummingbird, Remedly, CureMD, Medical Mastermind and Epic. But the lawyers and the economists got priority, so that EMR’s are great for maximizing charges and avoiding malpractice claims - by including a ton of, mostly totally superfluous, information so they create totally unwieldy documents (try reading an ER progress note or discharge summary some time).
I also would like to talk to the people (presumably geeks) that build EMR. I would ask them why I have to scroll through multiple screens. pick lists, drop down menus and make a zillion keystrokes, just to do something as simple as order a lab test or write a prescription.
Also, why I have to over-ride a potential drug interaction warning when prescribing glucose testing strips– those strips you put a drop of blood on an stick in the meter to tell you your blood sugar – which are not a drug of course.
I would also ask “did you ever talk to a doctor in developing this?”
The greatest short coming however is lack of “interoperability”. Interoperability is a fancy word for computers being able to talk to each other. This is what makes you think, when you come to see me, I have all the records from the hospital, other doctors, the lab, the imaging department and know all about you.
I don’t. My EMR won’t talk to the majority of other EMR’s, so we have call to get records faxed then scan them in the chart.
These shortcomings are annoying – but they have a more serious side. EMR has been accused of being one of the prime causes of doctor burnout – which is hitting epidemic proportions.
I called Dana Tate, president and CEO of Fredericksburg medical billing company ‘sa medical of Virginia’ who has a lot of experience of different EMR’s.
He did tell me the system we have at Moss is not one of the most user friendly (anyone want to start a GoFundMe to get us Epic?). But he noted a lot of older doctors are retiring because they can’t hack the EMR. “The younger doctors who have grown up with computers are dealing with it better.”
I guess I fit the old-farts category. A dinosaur in the computer age having trouble adjusting. But it bugs me that the business side has had priority. To quote the NIH, EMR’s “seem to be badly designed to do the job they are meant to do and seem to have failed to make patient care better, more efficient, or more satisfying for the patient or the doctor.”