Saturday, August 24, 2019

The Continuing Disaster of Electronic Medical Records

EMR's have been a disaster for clinicians.  As a patient, I like the patient portal, where I can get and receive messages, cancel appointments, get lab tests, etc.  But doctors are reduced to data input clerks, become much less efficient, and as some say, have their souls sucked out of them.  Here is a brilliant exposition:

 It is such a violation that the decision makers for purchasing these things, the government and the administrators, victimize the doctors by their own ignorance and lack of advocacy for the doctors, and for the entire system of medicine, if truth be told.

This has been known for some time, but there is no sign of improvement.  We're stuck.  Government is doing nothing.  Judith Faulkner, owner of Epic, remains a billionaire who obliviously observes, "Why would a patient want his medical record?"  And Epic then produces records that no one can really use well, neither patients nor doctors.  But they are good for billing!

Others say that doctors are just too stupid to use the EMRs correctly.  Right.

Medical care is becoming like the weather, everyone complains about it but no one does anything about it.  To me, the answer is strict government regulation of anti-trust measures, and vigorous pursuit of interoperative EMRs, regulating Epic and others as platforms, mandating that innovations from other companies be open for incorporation into them.

In medicine, corporatism is failing, as it has in so many other walks of life, because government has failed to regulate the marketplace so that competition is strong and works in favor of the consumer.

Just to make the feelings of doctors vivid, here are two trenchant comments from the American Academy of Pediatrics, Section on Administration and Practice Management Listserve:

Oh, man, he is singing my tune! (referring to the ZDog clip that started this post.)  I literally grew up with computers dating back to the Commodore 64 and Vic 20. I learned to program as an elementary and middle school child and was always very pro technology.  I was an early adopter of the palm pilot and handspring devices because they were innovating and creating new and more efficient ways to care for patients.  I used a Palm device to do my progress notes in residency and was able to do so efficiently. At that point, the technology increased my efficiency and organization, so I used it. 

I finished  residency and spent the first 11 years of my career on paper and was rather efficient. I saw roughly 6000 patients a year and then transitioned to electronic records. 

 After four years on Centricity, I can only see about 4000 patients a year while working longer hours.  Additionally, the quality of what I am doing for my patients is worse than what I was able to provide when I was on paper. Among other things, this is why I am finally setting out into independent practice.  At least I can choose my EHR this way. 

 All this to say that we could keep virtually every benefit of electronic records and regain quality and efficiency if we could return to paper for almost everything except a problem list, allergies and medications.  Perhaps in the hospital you might want to include a few other features, but undoubtedly you could make the system much more efficient and improve quality of care by eliminating most of what has to be done in the computer.  

My two cents,

DS, M.D.

I could not agree more.  While I did not grow up with computers, I was an early adopted of the Mac platform in 1986 when the 9” mac cost more than $3000 and had a 20 megabyte hard drive and floppy disc!  I used to love the Mac until, in recent years, it began to copy Microsoft in being packed with “features” that the average user did not comprehend or need.  It is still the best around, but getting harder and harder to use.

I too could see 6000-7000 patients yearly on paper.  Now, 4000 is a stretch and it is solely due to the adoption of the word vomit producing, time sucking, soul killing nearly useless EMR, also with much longer hours needed to be a click monkey.

The only useful part is ERx and allergies and legibility.  All other “improvements” in data collection, population health, and better care have been total vaporware.

Thank the government for essentially mandating the adoption of mutually incompatible, horrible programs for all, without any effort at producing a universal standard or insisting on user friendliness.

IMHO it has been a total disaster.  Longer hours, no eye contact, box checking instead of history taking, choices limited by databases, not by what you need and the total loss of ability of the clinician to find any useful nuggets of data amid the pages and pages of word vomit spewed forth by EMR.

And that was me being polite.

HL, M.D.


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