Health Care Politics Paperless

Physician, Steel Thyself for Electronic Records

Bumped from last October.

I have had conversations with physicians that reflect essentially the same complaints as expressed by Dr. Valinoti in the WSJ article quoted below. They have had an EMR thrust upon them by a hospital or some other administrative body and they find it to be impossible to use effectively.

At first I thought EMR sounded like a good idea. Then our practice started using one. Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data—their race, their preferred language, and so much more—required by Medicare to prove that we are achieving “meaningful use” of our EMR. What “meaningful use” means no one knows for sure, but our manual on how to achieve it is 150 pages long… (emphasis mine)

As a colleague remarked, it seems as if this is all about taking care of the chart, as opposed to taking care of the patient.

via Anne Marie Valinoti: Physician, Steel Thyself for Electronic Records –

There are so many issues here but one of the most important is that the EMR as it finally emerged was not designed to serve patients or physicians but to meet a government regulation for “meaningful use” in order to get some federal dollars. Instead of entrepreneurial startups creating visionary products that will compete in the high tech healthcare world of the future, each pitted against the other to provide a great product at a reasonable price, we have bureaucrats and managers cobbling together an awkward beast that real people in real medical situations cannot use – but it does qualify for federal subsidies.

As a general rule market driven products strive to satisfy the needs of the consumers and if they don’t they either get better or fail. The result is improved products that enhance our lives at ever lower prices. For non-healthcare examples we only need to look to the computer revolution fueled by the competition between Microsoft and Apple or the automobile battles between Ford and Chevy a century ago. On the other hand political driven products seek not to satisfy the interests of the consumer but the special interest groups with the most political muscle or the best sounding story for the public. Political driven products rarely consider cost.

The complaint is that the new EMR takes too long and requires things that are not essential or even relevant. And by require I mean that the system refuses to allow the user to proceed until the required fields are filled in. Fields like race, preferred language and smoking status. Sure these might be important but do they have to be filled in before you can even get to ask the patient why they have come to see you?

The reason they are required is that some special interest thought they were important and another interest group wanted to be able to collect the data and together they had the clout to convince the bureaucrats to include them in the regulations. In an ideal world it would be nice to know all these things and the doctor should record them and eventually it would be valuable to have then for research but in the real world we end up with an unusable mess.

On the other side of the coin I had the misfortune to partake of our medical system a few years ago. I went from admissions to radiology to surgery and at each stop I was handed another clipboard and required to fill in essentially the same thing over and over; name, address, insurance info and a basic medical history. They could not even manage to transfer the data from one part of the hospital to another.

A basic EMR would have made my experience much better faster and more efficient not to mention save the hospital a great deal of time, personnel expense and records storage and retrieval costs.

I hope the physicians don’t give up and throw out the EMR baby with the “meaningful use” bathwater. EMRs should be a wonderful improvement to medical care but only if they are designed to provide what physicians and patients want and not what the bureaucrats think is politically important.

Related: 2014 Not a Deadline

One reply on “Physician, Steel Thyself for Electronic Records”

We think that digital record is the way of future. At Santa Teresa Dental, we have been using digital radiographs, dentrix paperless questionnaire module for years. It makes life much easier and. It saves staff time. No more charts to pull! No more putting patient on hold to pull charts! No more hard-to-read doctor handwriting! Referrals are much easier. Not to mention that it saves our planet! We hope that by stating the benefit, more offices will be following the model.

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