So youve heard of the Electronic Medical Record, or EMR by now. Starting in early January 2015, the HITECH (Health Information Technology for Economic and Clinical Health).But its already been in use and incentivized since 2012. And you may even have an inkling of how it is supposed to help health care. Maybe you’re all for it. Maybe you’re not. Maybe you dont understand how it affects your health. Maybe you dont understand why your doctor doesnt look at you anymore, and stares at the keyboard when he’s talking to you. I’ve been compelled to blog about this, because I feel its damaging patient care. That may come as a surprise to you, I understand, but its the truth. And I have hundreds of doctors who can back me up on this. I know its mandatory, so dont freak out, I use mine to the letter of the law. But the EMR has some serious problems. Let me fill you in.
The biggest issue. Time. It takes alot of time to document in progress note. I spend about 25% of the day seeing patients, which is sad, because its actually my favorite thing to do. I sometimes think how blissful it would be to spend 80% of the day seeing patients like back in the 70s. Unfortunately most of it is spent filling out forms, prior auths, calling labs, medical equipment companies and going to sleep, group, and hospital meetings. And and dont forget the 2-3 emails per day regarding EMR, meaningful use and data. The EMR takes a considerable time of the 75% remainder of the day. And even more if you dont know how to type. (I do )
Face to face communication. Do you wonder why your doctor documents on a keyboard in front of you? Because this time isnt built into the day. We try to schedule the way things were before the EMR, and it doesnt always work. Which is why you wait in the lobby longer. Also doctors dont get paid for the time it takes to do the EMR notes, unless it is in front of the patient. They dont get paid if they document after the visit. Thus, you should go ahead an expect minimal eye contact. Its our govt regs at work, and it is the new norm. I have had many a patient leave their primary care docs for this reason alone. It is destroying the patient physician relationship. Paying attention, and catching nuances is important. And if youre typing on a keyboard during the visit, it doesnt appear that you care. Unfortunately, it cannot be escaped.
Downtime. Our EMR or fax servers generally go down twice a week. Typically for an hour, sometimes two. It may not sound like a problem, but when it happens, it cripples us. No paper charts. No backup. When it happens, we dont know who is on the schedule or even who is in our lobby. Sure we can fall back on paper during these times, but there is no access to names, records, or schedule. When the fax server goes down, our hundreds or inbound and outbound faxes get backlogged. Then the phone starts ringing. Where are the orders? Where is your referral? The pharmacy says you didnt fax the script. A patient didnt get their work letter. And what can we do? Nothing. Unless you want us to snail mail it.
Improved care? It may or may not be helping patient care. With limited access to doctors, and time being filled with EMR use, we may be cutting patient access. Those that are here get less attention, as the focus is on EMR. We have dozens of EMR “rules.” Notes locked in 24 hours. Template requirements. Documentation requirements. Benchmarks. Meaningful use. Stuff that wasnt taught in med school. If you only had any idea. Not to mention, all that legacy data. What happens to the old paper charts- they get scanned in. So instead of flipping through pages, you have hundreds of PDF pages to resize and scroll through. Ever try to read a 100 page PDF? Ever find it tough to find what youre looking for? Ever give up?
What about when you have too many cooks in the kitchen? You may have 10 doctors, and one med list. By right when a med has changed, it should be reflected in the list, and it often is. But we have learned that if you did not make the change, and another doctor did, its best to let them make the change. Otherwise it looks like the sleep doctor is making BP pill changes. “aka BP med list updated 5.14.13″, then you get a nasty call from a PCP office. So patients often say, I m not on these 3 meds anymore. We have to say, your pcp has to make that change. Its their responsibility and their liability. We dont manage them so we dont change them. Otherwise fur flies.
Oh and dont assume all docs are on the same EMR. Dont even assume all docs in the same practice or group are on the same EMR. Why does that matter? Because your progress notes are not able to be viewed by other docs taking care of you. Sure your tired of filling out forms and history and listing out meds 20x, but the fact is, only a small proportion of use can see everyones notes. Dont assume we can. Thats why youre repeating it. EMR was support to improve patient care, but instead it blocks it. Its like having Windows OS, Mac OS, and Blackberry OS, trying to communicate with each other. They cant. Then you have to request notes from the other doctors (after an agreement form of course), have them print from the EMR, then fax 100 pages of documents…and a cover sheet. Thus creating more 100 page PDFs. Circular isnt it?
The software is beta. If you are a developer, you know what this means. Its crappy. Ours freezes, shuts down, logs us out, and fails to load templates…at least 3-4 times per day. Then we have to log out or reboot…while patients wait. It reminds me of Windows 3.1, and maybe you are too young to appreciate it. But it was terrible. Slow, buggy, and in the way if what you truly wanted to do. You see, with the mandate, physicians were forced to buy EMRs asap. And what a great advantage to EMR companies! You are forced to buy them, so just get a product out there, bad or not, they will have to buy it. Its like if you had to buy a Windows phone. Now. What if you didnt want one, or it was inferior to other products. Thats too bad. Its mandatory. Mandatory doesnt drive innovation.
I might add that, without a doubt, EMRs are designed by tech nerds who have never seen a patient in their lives. They blow smoke acting like they know but they dont. What you get is an EMR designed to be data mined by companies for profit (another very long and true story) and not something actually usable for a clinician. If you are reading this, and you are in the industry, take note. You are doing it wrong. If you want to consult a real physician who is a programmer, coder, and web designer, you know where to find me. Yes, I am willing to help. You need it. Badly.
So there you have it. Its all out there. This should give you a better perspective of where health care is and where it is going. Again, I’m not saying Im not using it. I cant, I’m mandated to use it. But it is killing out health care system. At the very least, the EMRs need to be one hell of alot better. At the best, there should be more flexibility with billing and time, so we can document after the patient visit and actually make eye contact. Isnt that what patient care is all about?