EMR: The Story Behind This Cartoon
This cartoon animation has appeared on this blog in the past. There is a backstory.
More than ten years ago, at a hospital meeting to plan for a new Electronic Medical Record (EMR) at huge expense and required “buy-in” from the physician community, I raised my hand and stated a complaint: “None of these products talk to each other. You are effectively mandating that all physician groups must choose the same one or two EMR vendors. I received a condescending response from the physician leading the meeting about how this was simply wrong. I was apparently terribly mistaken and foolish for being so ill informed.
People talk in a community our size. I learned that hospital administrators were unhappy at my objections. They were telling people I was old and getting ready to retire. The message was: “He’ll soon be gone. Don’t waste time with him.” To set the record straight, my hair is prematurely gray. I am 63 (meaning I was in my 50s then) and plan on working into my 70s. I like my job.
So… Was I a mistaken cranky old doctor? Flash forward more than a decade. Our HCA hospital’s EMR does not talk to our bigger hospital running EPIC. You must run both programs on your PC to see records at the two hospitals. The HCA program runs on a virtual machine, making your computer less stable. Basically, the care team at one hospital is blind to the care at the other hospital. No hospital employed doctor at HCA can get at the other hospital’s EPIC records and vice versa.
Additionally, the EMR vendor pushed hard by the hospital to local practices suddenly shut down the product within a couple of years, mandating an expensive transition to a new EMR. Due to the contracts, the new EMR was already selected and you had no choice. The expense of this caused the collapse and closing of several primary care practices. Those who bought into the hospital’s plan, at significant expense, paid an even higher price.
More than a decade later, none of the original EMR’s are even in use and still none in our community talk to each other. This is dangerous. It is also deliberate. Doctor concerns about EMR interoperability have been totally ignored. Doctor input was completely crushed by the relentless profit machine of EMR. They know it hurts patient care. But, they are unmotivated to act because they make more money the way it is.
To make matters worse, EMR’s have a way of becoming acquired by bigger companies and then shut down, sending you to a product you really never wanted. Most EMR contracts make extracting your practice from a bad EMR very difficult. Even when an EMR corporate buyout forcibly sends you to an unwanted EMR, you may find yourself legally trapped. Allscripts is the example here.
In the early days of EMR, medical staff were inundated with a variety of hospital sponsored “education sessions” to sell the value of EMR. Though the presenters were perky and optimistic, there was always a somewhat threatening undertone to the lectures. Those of us who questioned the systems were putting patients at risk, they said. We were antiquated and dangerous. We were compared to early doctors who resisted using the stethoscope more than two centuries ago.
Almost fifteen years ago, I created an animation about EMR. It used the theme of the EMR becoming self-aware and played with the concept behind the Terminator movies. It mirrored a reality we encountered at our local hospital. One weekend, the EMR went down. Orders could not be placed. Even food for patients ceased. It was a real disaster. We were delegating control to a system that had the capacity to cease basic hospital functions when it misbehaved. How could this not be hazardous? The backup procedures proved less than adequate.
It got a lot of views and I felt pretty good about it. The comments were ugly, though. Obviously, it hit a nerve. It was as if every EMR salesperson was being directly insulted by the video.
Unfortunately, the name of the fictional EMR in the video bore some resemblance to a hospital software produced by a large international corporation. It was spelled totally differently but phonetically was similar. Months after I posted the video, I got an email from the legal department at the company. The message was simple: “Your video is funny. Ha. Ha. Take it down now or face expensive legal action. This will be your only warning.” Basically: Free speech is one thing, but you can’t afford the hell we can cause you.
I took the video down. I was a little bitter because the threatening attorney revealed our local hospital had a role in his message. Anyway, this was not a battle I could afford to fight.
About a year later, I recreated the video and just referred to it generically as “EMR”. Unfortunately, when I took down the video more than a decade ago, all of the comments disappeared as well. That’s sad. More comments have accumulated, but they miss the old spark and venom of the original angry messages. (Actually, I just read some of them and they still are pretty obnoxious…)The company, which felt its reputation was so fragile that my little video could wreck them, will not be named in this post. Okay… Here’s a hint: The company was a corporate participant in the Nazi Holocaust.
Now I’m curious as to the EMR company! Was it Bayer? Basf? IBM? The entire country of Switzerland?
Does Phillips make an EMR? What about IG Farben?
No matter. They were all de-Nazified in 1946… Right?
Many kudos, and several points to add:
Since the dawn of (wo)man, superstition gave way to theology, and theology gave way to superstition, again. We believe that Artificial Intelligence will lead us to paths that we never would have imagined. (Cut to lemmings rushing off a hill.) Lemmings do not mean to harm themselves or others – they just think outside of the box once in a while. This causes fewer lemmings.
Just because you can hammer a nail with a pipe wrench does not mean that it is being used according to its intention. Keeping medical records on an EMR is like hammering a nail with a pipe wrench. It is a billing magnifier, not a medical chart.
The battle of Progress vs. Traditionalism is ancient. One weapon of the Progressives against the Greyhairs is that they Grey-Haired fuddy-duddies are afraid of change. (Cut back to the Council of Lemmings.) Traditionalists just note that the connection between great ideas and their implementation does not always go as planned. This is hardly a new observation. (Cut to the Tower of Babel)
America is more or less cut from Progressive principles. People left their old homes for a better life, goes the legend. Except not the people on the Amistead or other “opportunity yachts.”. They left their homes rather unwillingly to come to America to be slaves, or chum the Atlantic on the way. I find that African-Americans are sometimes more dubious about the promises of Progress than others. When Progress is mentioned, African-Americans are usually the ones who take it on the chin. Call me a bigot, but African-Americans often have more common sense about The Big Picture. It never hurts to be cautious, or wary.
I notice all the kids who went to Pleasure Island in the cartoon movie Pinocchio looked (and acted) pretty much like frat boys. Tells you something when the EMR hucksters come to your town promising new electronic devices. You may be turned into a jackass.
This was brilliant!