The Electronic Medical Record Mess

emr

I am now using my third electronic medical record system.  There are tons of positives to it.   The negatives, however, are starting to build up more and more.   The reason?  I think it is due to the increasing mandates from administrators, governments and others who are not involved in the care of the patient.   They add more and more clicks which takes more and more time out of my life and from treating (or even looking at) the patient.  Anyway, the result is that you WORK for the EMR/EHR instead of the EMR/EHR working for you.  I am not alone in thinking this.  The Family Practice News has a section written by an residency director and a resident (both not in the real world) and jumped into the fray about EMRs.    They were initially pollyanna about it; that is until the readers have written back.  It has been great to see that other docs have the same concerns I have.  Please check out the articles here to feel that you are not alone.  I know they are not putting in 1% of the negative feedback they have received in order to give some hope.  Sorry, there isn’t any.  It is a mess.  I won’t edit any of your comments so share them here and let’er rip.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “The Electronic Medical Record Mess

  1. Brian Battista
    October 5, 2013 at 1:04 pm

    I have had an EHR for 3 years. I had heard that EHRs were,”a year of hell, and you wonder how you worked without it.” We’ll, I still find it agonizing to use. It is a formula for errors, inefficiency, and loss of productivity, for the reasons that others have detailed. Providers at our group practice uniformly have lengthened office visit times to see patients, which sounds good for patients. However, that time is spent entering data, looking at a screen and away from patients, searching for diagnoses in a pathetic database, etc.
    These computerized records are strictly for data mining by the insurance companies and the government. Period.

  2. Carol Kaufman M.D.
    September 25, 2013 at 9:22 pm

    I’ve been an FP for over 30 years and EHR has driven me from private practice to a public job. Relatively early on, our private practice acquired a system and became totally paperless. I mastered the system, appreciated it’s advantages (many) but hated it oh, so much more. A chart note should succinctly and clearly convey the visit transaction with little extraneous or distracting information; the gobbledygook and misleading misinformation that comprise today’s EHR product is frightening and detrimental to good medical care. I think that a good part of the initial problem with EHR is that early software developers relied on input from computer-lovin’ M.D.s who were happier looking at a computer screen than at a patient; the ‘early adopters’ were often compartmentalized thinkers. As a clear communication tool, software product is primitive and inadequate. Software companies should have sought out M.D.s who DISLIKED using computers and crafted software based on their abilities and thought processes. In reality, the technology (i.e. reliable , rapid voice recognition software) has not evolved to the point of acceptable use…and this was all BEFORE external QA/Care standard reporting was so omnipresent. Well, I now work for a deeply destitute state system, and EHR is light years away—unless external mandate forces the issue!

  3. Stella Fitzgibbons MD
    September 25, 2013 at 2:51 pm

    http://todayshospitalist.com/index.php?b=articles_read&cnt=1727 I wrote this because of a multihospital corporation saddling us with a bottom-of-the-line, “what we used before we put in stuff doctors actually NEED” EHR. I tried to maintain the position that even a @#$% system is capable of improvement…but the inescapable fact is that this is a way for the hospital administration to keep numbers on us and to make our lives miserable. My only hope is that doctors considering using a hospital for their patients will start to figure its version of the EHR into their calculations and TELL the hospitals why (“I’d love to operate there, but your Mark One version of Cerner takes too many hours out of my day.”).

  4. Arnie
    September 25, 2013 at 11:06 am

    Actually I have come to have a love hate relationship with my EHR. I don’t have to type anymore. I can carry my IPad into the exam/treatment rooms and simply click a button, speak my positive findings, click talk or exam the patient again, then tap the button on the screen and dictate more. Finally after clicking twice and with the use of the office WiFi, my computer opens a screen and types away. All I have to do is correct a few words type in error, add negative multi-variable templates of ROS, The work is done without clicking many squares to end up with a simple SOAP which can be interpreted by our government RAC people as inadequate for higher level E&M visits. Very costly if you attempt to pen sufficient notes and avoid a giant fine.

    I have become used to not carrying charts to the room and can instantly see the patient’s previous visit notes, labs, x-rays, etc.

    No more SOAPs for our practice.

  5. September 25, 2013 at 10:55 am

    Private practice EMRs are sometimes OK… Hospital EMRs are uniformly awful. Cf “How an EMR gave my patient syphillis” for a review of the realities on the ground. 🙂 http://getbetterhealth.com/more-unintended-consequences-of-digital-data-how-an-emr-gave-my-patient-syphilis/2013.08.22

  6. Pat
    September 23, 2013 at 11:04 am

    I have a 25-year old tropical bird, who is a dear friend, and an avid reader of “Family Practice News”… noting that his editorial responses, like those of the publication, are always the same.

  7. Ken
    September 22, 2013 at 11:53 am

    It’s nice to see notes, labs, etc on a screen with a push of a button, however it is madness to pay physicians to do data entry, and the fact that medical administrators cannot see that only indicates the level of their incompetence. This sounds like just a whiny over-generalization, but this has been true in every place I have ever worked.

    • Kurt
      September 25, 2013 at 5:46 pm

      Computer speech recognition is still too slow in my situation. Stuff is getting lost in cyberspace
      or never arrives from tertiary care centers. I come from a group that had an excellent paper system. I no longer recommend primary care for students as being paid for production simply doesn’t cut it anymore. Can’t see as many folks and staying late to finish up the keypunching.
      There goes the so-called quality of life for an FP person.
      Unless one sees the same types of patients,(I hear Ob’s/Ortho’s love EHR as click,click the “canned” visit is done) for primary care, it’s time consuming and sucks. I no longer recommend primary care to students and wonder what BS the academics are feeding them to keep the residency places filled. Don’t they know they will just be competing with NP’s and if they don’t do hospital work, they will likely not be able to make up the lost income by seeing enough “more” patients to compensate?
      I know about the NP thing as they are in the practice and do a pretty darned good job.
      Oh happy days.

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