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Electronic Medical Records: not the system I was hoping for!

Oct 22, 2013

This has been an interesting few weeks in my relationship with electronic medical records (EMR).  I spent mandated training time for upgrading the EMR system and when I asked the trainer what benefit I might receive with the upgrade (hoping for more efficiency, a blend of clinic and hospital computer systems, less boxes to click etc.) I was informed that there would probably be no benefit for my practice.   During the same time period, the hospitalists requested that I provide them with a short paper version of the order set for discharging patients with diabetes, as they are overwhelmed with the options and find the process incredibly time consuming.  I spent time crafting a new series of “smart phrases” so that orders for correction doses can be specifically geared to the patient rather than generic doses that really don’t fit the patients’ individual needs which are embedded in the EMR.  And in chatting with a friend who recently had surgery, her physicians hired a transcriptionist to fill in the boxes and write up notes.  Voice recognition has replaced transcriptionists, and errors are not discovered until it is problematic and incredibly time consuming to correct. 

I have to say, I am a bit disappointed in these multi-million dollar systems that are now required for our overstretched health care budgets, reducing efficiency and taking our minds, hearts and focus away from caring for our patients.  The dream of having electronic medical records talk with each other, streamline the patient care system and most importantly, enhance the care of our patients at this time appears to be a failure in many aspects.  Medical providers across the board (MD’s inpatient and outpatient, nurses, physical therapists and diabetes educators) are so focused on making sure all the boxes are checked, that patient care may truly be compromised. 

Perhaps even more intriguing is the concept that we are helpless in this impersonal health care delivery system,  discouraged to speak out and urged to ”just learn to accept it”.
 
In a few weeks, I leave for another medical mission trip to a third world country.  We will be working with patients, listening, holding their hands, trying to understand how we can help.  It will be refreshing to concentrate on the patients without paperwork, computers, and check off boxes.  I hope we never completely lose sight of our mission to care for individuals, touch them and realize it really isn’t just about boxes.  I am not against progress, and think there is some value in EMR – sharing of labs, drugs, and CAT scans, but I think we need to recognize the new challenges we are facing and not just put our heads in the sand.  Have you found a personal, caring and efficient way to incorporate EMR into patient care?  If so, please share your stories!

3 comments

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  1. Oct 30, 2013

    About eight years ago we fully implemented electronic medical record (EMR) at our institution; I believe that the struggles associated with new implementation is similar for most organizations. There is however, "a light at the end of the tunnel". Today I can communicate instantly with a provider and request follow-up with an urgent matter on a patient who is leaving my office for his/her next appointment with that provider. Hence the care is expedited and a potential hospitalization is likely avoided. The care received by this patient was more effective and efficient because of EMR. However, I must say that it took several years for this to happen. Please be assured that there is no turning back from EMR. Coming soon is electronic evaluation of the care provided, and prior to reimbursement by payers. This ensures quality and value to a patient. I worked on this project, so I know that it is coming. Thinking about EMR in the following terms made it easier for me: “how will we know that you have provided excellent care to a patient, if not for the documentation that is available to the next provider?" Good luck with your future endeavors with EMR. Someday you will grow to like it as I have. Now I wonder how I managed or previously survived without EMR. So in this regard: "there is a light at the end of the tunnel".
  2. Oct 28, 2013

    Follow up to my comments, as I read my comment this morning, I would like to apologize for the many typing errors, clearly standing out throughout the lengthy comments I posted. I also apologize for mis-spelling Carla's name a couple of times. I realize how irritating it can be to read a piece with many typing errors, but I did the usual mistake of not proof-rreading my comment, which I wrote in the rush of a busy Sunday afternoon! So, again my apology to Carla and to all AADE's blogg readers. PS. I did proof-read the above, but who knows so my apologies if there are errors in this apology comment. Saleh Aldasouqi, MD, FACE Associate Professor of Medicine Michigan State University
  3. Oct 27, 2013

    Well-done Carla, As a busy practicing physician, I echo clara's statement: "The dream of having electronic medical records talk with each other, streamline the patient care system and most importantly, enhance the care of our patients at this time appears to be a failure in many aspects". Despite the many advantages of EMR as you illustrated (prescriptions, obtaining reports, etc) the negative effects of EMR on clinicians as well as on patient-doctor relationship-- are too many. At the level of clicians: In my opinion, clinicians (providers inncluding MDs, NPs, PAs, as well as Dietitians, Educators, etc) are the ultimate (unaccounted for) victims of EMR. They are the ultimate victims because they are suffering all the burdens of EMR. They are now not only taking care of thoughtful decision making that is required of clinicians, but are performing extr tasks that should be performed by non-clicians (clerks, nurse, transcriptionists). One recently retired endocrinologist once shared that EMR, while a great tool, has added at least 2 hours to his day?! I am hearing similar comments from some of my peers (the generation that was not born or raised in digitally-dominated households)-- comments like earlier retirement! At the level of patient-doctor relationship, I am afraid that because of the burdens imposed on clinicians by implementaion of EMR's-- that patients have begun complianing that their doctors are not listening to them any more, because they are spending more time staring on their screens and keyboards, and checking boxes, typing and filling in spaces with data/info. These complaints have begun to emerge: Just ask your patients what they feel, or listen to some of the discussions that are beginning to appear in the media. All of this is coming at a time when clincians are being asked more patients in lest time!? I can share more stories, but I will stop to hear other comments on this critical emerging concern. Like Clara, i am not denying the many advantages of EMR, but it seems that there should exist an evaluation of the effects of EMR on these an accounted for victims, as well as on the negative effects on patient's satisfaction with their clinicians. After 18 years of practicing medicine, currently leading a busy clinical career and a a prolific career in research and authorship (following 6 years of medical schooling and 12 years of postgraduate prepping and training)-- shall I say that I am looking forward to an eariler retirement than I had previously planned?! I am not sure, but if this current status with EMR's burdens will continue, I believe the answer will be an easier "yes"! I have to disclose that while I belong to the non-digital generation, from the old school, I am very savyy in computers: I began using computers in the late 1970's (self-learning BASIC, COBOL, and then DOS), and had a professional course in typing after high school (so I type quite fast). I have been using all electronic gadgets beginning with Digital Word Processors, to the earlies Mackintosh Compacts and the earliest vesions of PDA's and and cell-phones, and to every thing in between upon fast-forward. So, my frustrationfrom EMR does not stem from naiivity in computing! But IT is something, and EMR is a totally different thing. IT can be seemlessly applied in every other domain, but to apply it in the form of EMR is a Dream that is Doomed to Failure, in many aspects, as stated by Clara in her beutifully written blog. Untill and unless these concerns are addressed, I am afraid many doctors will leave the practice of medicine!? Saleh Aldasouqi, MD, FACE Associate Professor of Medicine Michigan State University, East Lansing, Michigan.

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