Posted by Bill Sandweg.
One thing you can say about Electronic Medical Records: They are a mixed blessing. In my practice, I read a lot of medical records. In the old days, they were all written by hand and I had to struggle with illegible handwriting. I still struggle with handwriting when I review office records but all the hospital records are electronic now. The good news is that I no longer struggle with poor handwriting when reviewing hospital records. The bad news is that the records are ridiculously voluminous and do not do a good job of conveying information about the patient. Sometimes it seems as though electronic medical records (EMR’s) are the hospital’s attempt to make my job more difficult. Turns out doctors and nurses are having lots of problems with EMR’s as well.
EMR’s were intended to solve problems. One of the problems they were intended to solve was the portability of patient records. When records were on paper, it was difficult to print them out and ship them to another facility when the patient showed up there for care. With EMR’s, records can be transmitted electronically in the blink of an eye. The patient can be given a disc or a thumb drive with her records on them and can take them to her new doctor or hospital. The old problem of bad handwriting, which sometimes led to mistakes in care, has been eliminated with the advent of EMR’s. Unfortunately, new problems have taken its place.
Most EMR systems start with a template and have the person caring for the patient fill in the blanks, usually by selecting a word or term from a drop down list. This unnaturally constrains the care provider because the provider is no longer able to use her own words to describe what is going on. For example, “The problem came on ________.” The care provider clicks on the blank and a drop down list offers a choice of words with which to fill in the blank. Usually, “suddenly,” “slowly,” or “gradually.” If the word the provider would like to use is not on the list, too bad. “The pain is ________.” Choose from “sharp,” or “dull.” The inability to use one’s own words to describe the patient’s problems and care frustrates the doctors and nurses who must use the system.
There are two main providers of EMR systems in the United States. They are Epic and Cerner and, according to many doctors and nurses, they are both terrible. Doctors and nurses spend way more time than they should making entries into the EMR. They have to log in, open the program, find the right spot by selecting from a number of tabs and work with the template built into the system. They complain the software is slow and clunky.
Here is an article by a physician who complains of excessive costs and time lost because of EMR systems that are not at all user friendly. He calls the current EMR products “hopelessly broken.” As he correctly points out there is no reason for this in this day and age. Software developers know how to create computer programs that are intuitive and easy to use. We encounter these programs on line every day where a slow user experience is unacceptable and Google brags about results being returned in thousandths of a second. But the big two providers of EMR programs have a corner on the market and little incentive to spend millions making major changes to their current software. In one study of a North Carolina orthopedic clinic, the adoption of an electronic medical record increased the amount of time the doctors spent documenting their care by 230%. Labor costs increased by 25% per patient visit due to the adoption of EMR’s. This is unacceptable.
While, as we have seen over and over, it is never easy to make changes when there is a well-financed business that will be hurt by change, it is a change we must make. The result of a successful change will be better patient care at lower cost. That sounds like a winning combination to me.