Tuesday, November 6, 2012

The unbearable lightness of being an EMR user

When I first typed EMR in Google, so-called “success stories” kept pouring in. Quite frankly, the only question these lacrimonials raised in my mind was: how much were these guys paid to praise the green fields of Lalaland? A little keyword fine-tuning led me to the stories I could honestly relate to: horror stories. For in real life, I don’t know one physician who climbed the marketing promise ladder and saw the light. We’re all stuck in Plato’s cave and it’s time to get out. What we are currently dealing with is a sad shadow of what an EMR should really do.

Poor design, cluttered screens, hardly customizable, lack of integration with other systems, data not searchable, data hard to find, threat to confidentiality, coding and compliance concerns, all vital signs point to the same diagnosis: today’s EMR is a super expensive Category 6 patient.  I’ll have plenty of bloggy occasions to delve into each of those concerns with survival humor. But for now, there’s one symptom I’d like to focus on: loss of productivity.

Back to Lalaland for a minute. Here comes an anonymous quote from one of those success stories that deserves to be cut open on the operating table if you don’t mind:

"Although I’m spending more time at charting duties than in past practices, I can accomplish a lot more.”

Well, I'm sorry, but I have a problem with the first part of the sentence. How exactly am I expected to consider this good news? Call me Dr. Nasty but it looks like my fellow doc is spending more time treating the computer more than he is treating the patient. And guess what, he’s not the only one:    

“So I am telling the nurses at my Ambulatory Surgery Center that because of the all the time it takes to do Electronic Medical Records (EMR) that I had to enter data at the lake when I go out there. Whereas I used to come out here and just mess around cutting grass and throwing sticks to Penelope, I now bring my laptop and log in to my office computer and EMR and try to catch up on charts. Think about it this way you will see how oppressive this is and going to be for the doctors that don’t do it but will have to in the future. I see 25-30 patients a day and it takes about 4-6 minutes to enter the stuff you did and learned during the visit. Well that is 150 minutes of EMR per day of seeing patients that I now do before work, spare moments during work and then after work and on weekends. It is a full time job staying caught up. I did them this morning after spin and have done them here at the lake this afternoon.” (John McHugh M.D)

Penelope is the dog, not the wife, right? Anyways. The point is: since when are physicians data entry experts? Since vendors and their pale geeks got stuck in their own cave and kept producing systems that have no clue about the way a hospital runs and how healthcare professionals work together. So yes, I’m afraid it’s time to voice THE question: could the nurse be right after all?

Here is where she’s definitely right: 1) When Teamwork and EMR met for the first time, only one of them survived. 2) EMRs have NOT been designed to respond to healthcare staff primary needs, starting with clinical documentation. Who have EMRs been designed for? We’ll have the opportunity to unearth this dirty little grave later on. But for now, here’s my humble take on the subject: an EMR without a detailed understanding of clinical documentation is like having the most expensive bottle of French wine in your hands but no cork opener. Talk about a missed orgasm.

I therefore declare the quest for the Holy Grail open: time to lay hands on a beyond-decent piece of code that atomizes the unbearable and lets us indulge in the lightness of being a 21st century physician. Call it faith, hope, whatever. I call it value for money.

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