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A Top Ten List for EMR

February 14, 2013

Today I’m doing anesthesia for colonoscopies and upper GI scopes.  Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution.  I’ll probably do 8 cases today.  I will sign into a computer or electronically sign something 32 times.  I have to type my user name and password into 3 different systems 24 times.  I’m doing essentially the same thing with each case, but each case has to have the same information entered separately.  I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system.  Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out.  Twice.

No wonder everyone hates electronic medical records (EMR)!  I don’t know anything about computers, and I don’t know what systems other hospitals have.  I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it.  Nevertheless, here’s my wish list for a system that doctors would actually want to use:

1. ELIMINATE THE USER NAMES AND PASSWORDS.  You can’t tell me that in this day of retinal scans and hand-held computers that there isn’t a better way to secure data.  What if each person had their own iPad that you only have to sign into ONCE a day that automatically signs your charts.  If you’re worried about people leaving them sitting around use a retinal scan or fingerprint instant recognition system.

2. ELIMINATE THE PAPER.  If you’re going to have full-time people entering data for you, why print it out?  It’s on the computer for anyone to access.

3. ALL DATA SYSTEMS MUST BE COMPATIBLE.  You can’t have patient data entered in one place that doesn’t automatically import into another place.  If my anesthesia record can’t talk to the hospital OMR, I have to RE-TYPE everything in, which is completely ridiculous.

4. EVERYBODY HAS TO USE THE SAME SYSTEM.  Everybody, state-wide.  Right now, electronic records from a nearby hospital are not available at my hospital, even though the two hospitals are right across the street from each other.

5. DON’T MAKE ME TURN THE PAGE.  All the important information about a patient should be on the first page you open when you look up a patient.  I shouldn’t have to click six different tabs.  Specific to anesthesia, all the relevant data about the patient including what medications they have received during the case should be automatically displayed on the screen when you start a case.  Specific to primary care, all the latest labs and data, recent appointments with specialists, current med list and anything else the doctor wants to see commonly should be right on the first screen.

6. DON’T MAKE ME HAVE TO REPEAT MYSELF.  If I do eight cases the same way, with the same documentation required for each case, I still have to enter that documentation each time.  If I’m seeing 20 patients in primary care clinic and the rules require the same documentation for each person, I shouldn’t have to enter that documentation each time.

7. INVEST IN DEVELOPMENT OF REALLY GOOD VOICE-RECOGNITION SOFTWARE.  If I’m sitting across from a patient, I want to look at them and talk to them, not talk to them and look at a computer screen.  If my mother didn’t make me take typing in high school, I don’t want to have to spend 3 hours after-hours every evening pecking my conversations with my patients into a computer, or worse, checking boxes electronically.

8. GET RID OF THE WIRES.  In this day of wireless, why am I still tripping over monitoring wires and untangling cords?  My spin bike at the gym can pick up my heart rate without a wire.  Why can’t my anesthesia monitor?

9. IF YOU NEED A TYPIST, HIRE A TYPIST.  Every time a new rule or documentation requirement pops up, which in my institution is daily, it is always laid on the nurses to add that to their computer records.  Nurses used to be nurses.  Now they are data-entry specialists.  Their checklist and pre-operative paperwork is longer than mine.  And they aren’t doing any diagnosis or treatment.

10. TRIPLE BACK-UP THE SYSTEM.  Computers crash.  Paper doesn’t.  There’s got to be a way to make the system rock-solid reliable.


From → Healthcare

  1. Barbara Finn permalink

    Yes,yes,yes! Especially to voice recognition. I refuse to take part in interviewing pts without looking at them. Which backfires on me at the end of the day. The deterioration of personal care is largely d/t the computer intrusion and it has had the reverse effect of the hype in terms of access,repetition and overwhelming frustration,not to mention waste,increasingly of paper.

  2. I agree with all of your commentary. 10 years ago when I began my HIT quest I emphasized how important it was to design the user interface FIRST, and design the back end behind it. No one was listening because the vendors got away with selling less than optimal systems. They shot themselves in the foot..few were listening. It has taken painful incentives/penalties/certification to force MDs to use EMR for all the wrong reasons. The optimal situation would be for the patient’s voice to be recorded as you speak to them, with notes made by the physician to clarify what may not be understandable….you can give the patient the option to not be recorded while at the same time telling them it is important so that you (doctor) can concentrate and have eye contact rather than entering or transcribing while they talk. Computer processing is now powerful enough and voice recognition algorithms are over 90% accurate. MU and premature CCHIT certification deadlines have required many practices to buy incompetent systems. Billions of $$ have been wasted. Stop the travesty, now. Anyone who has an EMR that is poor must complain to ONCHIT, the FDA, the AMA, CMS, and whoever else. 800,000 MDs who are angry ought to get some reaction. Do not do not do not purchase an unfriendly system…it will cost you much more than what you would gain from any incentive and more than any penalties. There was absolutely no reason to rush this process. I still recommend that everyone discuss this problem amongst your colleagues before buying anything. Would you buy a defectiv care with controls that you don’t u nderstand or take six months to learn how to use effectively? Let’s stop being lemmings.

  3. I am a UK anaesthetist and Medical Director of CSC. I can empathise with your ‘cry for help’! We’re working on it!

  4. steve permalink

    Do you think every hospital has the capital and resources to implement the suggestions you have stated? Do you have any knowledge in regards to the complexity of systems you are referring to?

    • From the perspective of programming I do not. But as the consumer of the programming I expect to be consulted as to what I want. Then we can have the conversation about what is possible. Kind of like Bernie Sanders.

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