Electronic Medical Records Will Save Your Family
From a reader: “Saw this and just had to send it along. This EHR will prevent burnout and save our families!”
So let’s get this straight. Your life as a doc sucks and you are losing your family so go ahead and invest $100,000 or more into an EHR system and get an hour back of time. All that is bullshit except for the cost part. In actuality, the EHR will drive you nuts and the quality metrics and insurance hurdles will make you work even longer. It won’t change your work-life balance but it will give you better work-work balance, which means you can work more at home.
To clarify, I’m a PA x 35 yrs.
The last tenant been spent in interventional radiology. Prior to that 15 years in a hospital surgery department followed by 10 years and a private internal medicine practice.
When I joined the internal medicine practice, I was excited to purchaseA laptop computer, installed Dragon Naturally Speaking, and then dictated patient notes at the conclusion of the visit. At the end of the day I would print them for filing in the patient’s chart. Very convenient, didn’t have to worry about my crappy handwriting, and I could dictate into the chart more information that I ever wanted to write.
I remember carrying a palm pilot with a prescription writing program. Beam it to an infrared printer by our secretary’s desk, sign it and handed to the patient. The pharmacists loved it.
We made a very brief attempt back then to install electronic medical records. Cost was, of course, prohibitive, estimated at an initial $60k for minimal hardware and a monthly maintenance fee to cover upgrades and “tech support”…. If I recall correctly around $750/mo…. Our office was a small private practice consisting of two physicians and myself.
I subsequently left that office after about 10 years and started an interventional radiology. The hospital converted to electronic medical records about three years ago. Considering myself somewhat text savvy, I was excited at the thought of having a computer-based medical record. I have since changed my mind.
Considering myself somewhat text savvy, I was excited at the thought of having a computer-based medical record. I have since changed my mind. No dictation feature, no interface with other unimportant things like patient monitors, anesthesia machines, and poor interface with our Lab and radiology systems. I won’t mention crappy order sets, crappy note templates, and the propensity for people to cut and paste. It’s all point-and-click: Click a prompt, drop-down menu, start checking boxes. Don’t think about what you’re ordering just check anything that looks like it might be helpful. Oh geez, I I didn’t examine the patient! Well, nobody will know, I’ll just copy the assessment from the resident’s morning note. …… Are you kidding that to physical exam by CT scan in the emergency department.
But these are things that involve been discussed here before.
My current “pet peeve” is the amount of data the nurses have to enter in real time takes their attention away from the focus in the procedure room. The patient. This, in my mind, is a patient safety issue that must be addressed before someone is injured or dies.
Rant complete.
So I dictated that rant using my iPad.
I proofread it, made corrections, deleted duplications, then posted it.
I just read it. I had better performance and speech recognition with Dragon on that old laptop 20 years ago.
Was playing cards a few weeks ago with a colleague who was a fairly early adapter to electronic records–he’s had it for at least ten years. As 10 PM approached, I said I had to go home and go to bed because, after all, I had to work in the morning. Imagine my surprise when this guy said, “Me too. I have to finish my charts from today.” We’ve had EMR’s long enough that there should be a good one; unfortunately, the only ones worth anything are those designed by computer savvy physicians for use in their own offices. The commercial ones, all beholden to government mandates, are worse than useless–they bring negative value to the practice of medicine as demonstrated by Dr. Ed’s comment above.
Yup, that’s about right. Notice that EMR’s – unlike the lawyer’s professional software – doesn’t track or bill for the amount of professional time you spend from home doing eDoctoring. That’s all for fun & free. Da Cump’ny would hoot in derision if you asked to get PAID for your homework. If you go home Friday Night with un-checked alerts, and Mrs. Whistlestop’s INR came back at 3.5 Friday Afternoon, you get a kick in the metrics for going 72 hours without addressing the issue.
Back in the day, before everything was so fragmented, you’d ALREADY be watching for Mrs. Whistlestop’s INR already, and wouldn’t mind addressing it on the phone on Saturday morning. But not, it’s just like riding the Carousel o’ Blame, racing faster and faster….I’ve had ER’s “sign out” my patients back to my care by e-mail on Friday night, and didn’t hear about it until Monday morning….lawyers love those kind of shenanigans.
What real medicine can you DO in front of the computer at 11:30 on Friday nite when the family’s finished their McNuggets, the kids are in bed, the dog’s throwing up, and the ex won’t be by to pick up the li’l darlings until 6PM? The peace of mind that comes with defusing the various sh_t grenades that have piled up in the e-Massah box. Freedom’s just another word for nothing left to lose, sed Janis, yah. Crack a fresh wine cooler at midnight and toast the brave new future of medicine. They scold – we slink. Bet the CFO’s not on line at midnight on Friday catching up with her/his numbers. YOLO.
2 years in with Epic….
Interventional Radiology
EHR has added 20 minutes to each case….and I do 6-8 cases every day…. So 2-3 additional hours spent to keep same pre-Epic patient volume.
I also believe the amount of real time data our nurses have to enter during a case is excessive & a patient safety issue. Data entry takes them away from bedside and chains them to the computer.
Ed, I don’t know IR, but I surely appreciate your note. Somehow we have developed a superstitious belief in the accumulation of rubbish. EMR’s seem kinda like the poor homeless schizophrenic’s shopping cart, filled with immense wealth like pieces of string and street trash. The homeless psychotic has a fantasy that it is useful magic. He might scream if someone tries to loot his horde. That man’s fantasies originate in treatable disease. Our faith in the indescribable magic elements of technology seem little different – except our trash is vastly more expensive (as opposed to valuable.)
Some MBA or techno-nitwits will shriek about doctors being anti-technology. IR is nothing but a successful race to incorporate useful ideas into healing, and hey, what a job you guys do – thanks!
Look at the backstory of Chernobyl in the 80’s and the WTC disaster in 2001, and you can find the pathetic and horrible, clear as crystal facts in each that there were straightforward failsafe plans that would have stopped each from happening, completely. Neither was an “act of God.” But we calculate that expedience, inexperience and fear of violating ‘rules’ enforced by the ignorant, killed a lot of people. We have a metric that measures obedience, cutting corners and dishonesty, and puts them in the balance of human life – and have come up with the acceptable levels of completely avoidable deaths. Somehow, in a profession that’s all about life, this mindset seems as cruelly twisted as the Nazi doctors who erased the undesirables. Without morality, medicine becomes a wicked thing indeed – and we are racing towards that wickedness.
Love this, Steve O!
Well said.