Friday, October 23, 2015

Are Electronic Medical Records (EMRs) Fit for Patient and Physician Consumption?

There’s something subhuman with electronic medical records (EMRs), upon which the Obama administration has squandered $30 billion since its 2008 stimulus bill.

Physicians’ chief complaint is the waste of time and needless expense spent over inoperable, clunky, and clinically unfriendly EMRs.

Jeff Goldblatt, MD, a general surgeon in Old Saybrook, Connecticut, puts the problem in context:

"The need to complete electronic medical records leaves no time to see the patient to talk to the patient, to touch them. It has compromised doctors' ability to take care of patients while at the same time requiring that more people be hired to IT and coding. Lots of doctors have left their careers early as a result." (Beck Coffey, "Jeff Goldblatt: the Healing Life," Harbor News, October 22, 2015.

I once asked my ophthalmologist what he thought about EHRs. He replied, “When I receive an EMR from a referring physician, I ignore it. It doesn’t tell me why the patient was referred. It doesn’t give me any useful information. It’s just a bolus of data. There’s no narrative, no story, there.”

As Robert Wachter, MD, concluded during the writing of in his 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age,

"I realized that my beloved profession was being turned upside down by technology…Medicine is at once an enormous business and an exquisitely human endeavor; it requires the ruthless efficiency of the modern manufacturing plan and the gentle hand-holding of the parish priest;…it is eminently quantifiable and yet stubbornly not.”

In recounting clinical EHR “House of Horror” stories, Lisa Rosenbaum, MD, national correspondent for the New England Journal of Medicine says,

“To these tales of EHR fallout, most of us could add our own. Physicians retiring early, Small practices bankrupted by up-front expenses or locked into ineffective systems by the prohibitive cost of switching. Hours consumed by onerous data entry unrelated to patient care. Work flow disruptions. And above all, massive intrusion on our patient relationships." ("Transitional Chaos or Enduring Harm? the EHR and the Disruption of Medicine, " NEJM, October 22, 2015.

In a recent interview with me, Richard Armstrong, MD, a general surgeon at a small critical access hospital in Michigan’s upper peninsula, related this sad tale,

“In 2007, a small study of early IT investors, about 3500 tech geek adopters, were interviewed by the RAND corporation. When asked if they liked their systems, 95% of them answered “yes,”. The NEJM published an editorial which stated “95% of doctors like their electronic medical records.”

“Voila! The politicians and the IT industry pounced. It was stated to the general public EMR systems would reduced the cost of medical records, reduce medical errors, make doctors more efficient, and allow more seamless communication among health care providers. None of this occurred. ”

Voila indeed. This is an example of a vast project launched with half-vast, half-baked, and half-studied ideas.

Electronic medical records personify bureaucratic overkill in pursuit of wishful thinking – that somehow electronic documentation in the cloud are more important than clinical doctoring on the ground.

It is an example of a blind trust in data rather than clinical judgment , of wishful thinking that EMRs would speed the transition from volume-based to value-based payments, of the ideology that somehow electronic monitoring would bring precision into the subjective business of medicine.

But there can be no central interoperability of systems with operability in practices , no increase in efficiency or effectiveness unless EMRs help rather than hinder patient-physician relationships, no technological advances unless the “data’ tells the stories of patients and physicians’ effort to help patients. Hope and change and wishful thinking are not enough unless they address human needs and are fit for human consumption.

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