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EMR: Even More Ridiculous

December 12, 2012

A recent blog by physician-blogger Kevin Pho brought up the subject of electronic medical records or EMRs.  It got 55 comments.  People, there is alot of frustration out there, I’ll tell you for free.

Let’s start with the perspective of you, the patient.  When you go to your doctors office, does your doctor sit and talk to you, examine you, look you in the eye?  Or is he typing on a laptop?  When I go to the preoperative area of the hospital, all the nurses and doctors are staring at computer screens, even while they’re talking to you.  Do you mind this?  Even my own pediatrician does it, though I have to say she does it in the most unobtrusive way possible.  On the other hand, all your information is there and you don’t have to remember when you last had a pap smear and the doctor doesn’t have to dig through 500 pieces of paper to find out the information.  If you have an emergency and go to the ER, theoretically your information should be in the computer system if you can’t communicate yourself.  My institution has a computer system that is incompatible with the system at the hospital right across the street.  Better or worse?

The perspective of the doctor:  we hate it.  It’s theoretically a great idea to have all the data about you the patient in one place where it’s easily accessible and readable.  But guess who has to physically type in all that information?  Me.  Attempts to relieve me of this burden have been attempted in the form of paid and trained scribes with mixed results at best.  Other solutions include having the nurse do all the data entry, which sucks just as much for her and is not what she signed up for either.  In my institution all the data she enters has to be re-entered by me anyway.

Click boxes and checklists make it a little easier, but on the other hand click boxes are easy and it’s not a stretch to imagine someone clicking boxes just to have done with it.  This is especially true since there are so many regulations on what you have to document that half the click boxes concern things that I as the doctor and/or you as the patient generally don’t care about.  For instance: in my institution a nurse is required to ask about your shirt neck size if you are a man, and document it in her record.  Why?  Somebody got a bee in their bonnet about sleep apnea and now everyone gets screened for it, and neck size is one of the risk factors for sleep apnea.  The nurse doesn’t care about your neck size.  Your surgeon doesn’t.  Even your anesthesiologist doesn’t be cause she can take one look at you and tell if you have sleep apnea or not.

The perspective of the government: LOVE IT!  All that juicy data just sitting there ready to be mined for trends and laws and quality indicators and stuff like that.  That’s why the government has been throwing money at the tech companies to make these systems.

The perspective of the insurance companies: LOVE IT!  All that juicy data just sitting there ready to be mined for money.  Or the saving of it.  Theoretically, EMRs are supposed to save money.  I’m not sure why, but maybe billing is easier, maybe less repeat tests are ordered because people can’t find the results or they’re not accessible, maybe better communication saves hospital days.  I don’t know.  I’m skeptical.

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