The Tragedy of the Electronic Health Record by Steve Mussey MD
A great article appeared in the magazine “The Pharos,” the journal of the Alpha Omega Alpha Honor Medical Society.
“The Tragedy of the electronic health record,” is the title.
The cover of the magazine can be seen above and the picture nicely sums up the article.
It is worth reading and can be found here
Our various medical and professional societies have failed us miserably.
Electronic Health Records have delivered only disaster. Our various medical societies have done nothing but cheer the destruction of medical practice.
AOA is prestigious, but not known for complaining about the system. In fact, this publication is usually painfully bland.
This is the first time in 30 years this magazine made me pause and say, “It’s about time!”
The electronic health record is, indeed, a tragedy.
The obvious question: “Where was everyone when this was getting implemented?”
Looks oh so familiar. Why would our hospital place the computer on the wall beyond the foot of the pt’s bed? Could it not at least have been attached on a ‘pull out mechanism” so that a nurse/staff might face or at least have your side to the pt. rather than our back?. I hear that teachers have eyes in the back of their head–maybe—nurses, Drs
Architects can be as bad as EMR programmers at not asking users what they do and what they need, but over generations the smart ones have learned otherwise. I think health care architects are worse than most, like EMR programmers I think they get their ideas from TV, especially in seeming to think we spend most of our time standing at bedsides barking orders out to nurses. Before the EMR I was always baffled at why they seemed to think ER docs never sat down and charted or made phone calls. I also think health care might be the only computerized industry with no attention paid to ergonomic principles, and personally might have to retire early because of it. Everyone thinks charting takes no time, and the programmers don’t care if it takes all our time. No one asks.
The picture is hilarious. That was exactly me except I’m female. Poor Dr. kept apologizing and said he was used to facing his patients. I felt sorry for him.
A tragedy? That’s a bit hyperbolic. If docs would spend all the time learning the EMR instead of complaining about it then things would go much more smoothly.
Mr. Keith is fos. We are not controlling the computer, it is controlling us!! Any one of us can talk
faster than the fastest typist in the world hands down! The pulldown menus are a PITA, time wasting sham. Scroll click, scroll click, resize this, re-login into that… EHR in it’s current iteration
along with ICD-XX ( brought to you by: Idiots, Crooks and Derelicts version XX) is the leading to a quick demise of primary care medicine. I tell med students to vote with their feet… Specialize!
And………. guess what? All this “canned” patient information these things spit out will waste more trees and give patients more fuel so they can light their wood burning stoves and fireplaces.
I’ve been typing in 40 point type “directed” instructions for years with variable results.
Nothing. I repeat nothing is going to change in this country until people are held accountable for their “blankety blank” poor behaviors.
No Mr. Keith, it is not “learning the computer” that’s the issue. These things take more time than dictating ever did. Docs can no longer delegate tasks to capable support staff either as they must “piss” on everything now. I doubt you see more than 5 people a day, don’t take call or do hospital practice, are salaried, and have regular stated hours. Kurt
Then who would see the patients?
You must have a great program and lots of time to explore it at the point of care, where primary care docs are usually trying to cram too many things into ten minutes. I’ve worked with many and have not found a single American program who’s design indicates anything but contempt for the user’s time or what matters most in health care. Learning all the hard to find tricks and shortcuts won’t fix that flaw, and the professional trainers are too slow and often teach the worst way to do things, so just about the time one figures out the best way they are ready for a grade. (I can’t call it an upgrade when it hides my most used icons and took away the way to mark a task urgent, and changed the way to make a script I write into a template in such a way that it can’t be done from the best place to write scripts so they appear in the visit note and don’t risk erasing the entire note- or at least that’s the best I’ve had time to figure after two phone calls to “help”- long sentence I know but it could be a book….) Where do you work?
If these systems were truly a good idea, they would not be mandatory.
My proof? In 2000 my partner and I bought an EHR because it made economic sense to us. And we were right! That in NO way justifies forcing others to buy a product to comply with gov’t mandates. What is happening now is economically and philosophically wrong.
If the essay were truly honest, it would read “Horribly Stupid Ideas that We Have Inflicted on Others for Our Own Benefit.” None of these many things that Byyny lists, were complete surprises when they failed. From the get-go, they were internally doomed; but they served the purposes of the arrogant and ignorant, who inflicted them on others whom they held in contempt. Now the rug is pulled – it is too late to even pretend anymore.
About the only author with guts who is referenced in the article is Francis Peabody. His essay is treated like ancient liturgy in the first year of Medical School, and then promptly cast in the dustbin for practical reasons. See http://jama.jamanetwork.com/article.aspx?articleid=245777
He wrote the mission statement for humanistic medicine, and the warning about technocratic medicine, about eighty years ago. There has been a seamless thread bringing on the decline of REAL medicine over this time, and it has gone exponential over twenty-five years. It is telling that things have gotten so bad, even ACADEMICS can observe and understand it.
Here is an excerpt, not written about medical politics, but seventy-five years ago on a foreign continent, not by a disciple of the American Founders, but by an embittered Marxist-Leninist. I wish we were led by people who were so honest, right here at home.
Darkness at Noon by Arthur Koestler …not for the fainthearted.
I’m not normally a conspiracy theorist, but one really has to wonder…
EHR use has contributed to mistakes, put another layer between physician and patient, and cost enormous amounts of time and frustration to physicians and patients. Of course, it has also been tied to MU, PQRS and all the other garbage alphabet soup. In 2 months we will be facing ICD-10 which will only add to the time and frustration.
I think the point is to get doctors out of medical care and pave the way for less trained providers to handle medical care in the future based on algorithms. I see no other reason for all this.
Perry, thanks. But pitifully, it never is a true conspiracy. Because of the secrecy, the levers move and things change mysteriously, as though there were some unified but hidden mind behind the whole operation. But Machiavelli was a fool – nobody in power reads his stuff.
It is societal vanity. We have decided that the word “bullshit” is not to be uttered in polite company, that it is a vulgarity. That prissiness makes the university a more intellectually sterile place than the factory locker room, the barroom and the hockey arena.
There is no “there,” there. There is a parade of vain clowns and naked emperors, each a little more thuggish than the last. They start out as Philosophers, trying to model Plato’s Republic for the masses; and the worse overthrow the simply bad, until one is left with an illiterate Mafia thug running the show. THAT is how the “second alternative” plays out, and always have. That is why it turns out this way, every time, like clockwork, without a need or capacity for an intelligent conspiracy. It is no more intelligent than a forest fire, sadly.
I guess I was giving them too much credit huh?