Monday, December 28, 2015

The EMR Absurdity

What shall I do with this absurdity-

Oh heart , Oh troubled heart- this caricature,

That has been tied to me,

As to a dog’s tail.

William Butler Yeats (1865-1939

Most doctors agree.   EMRs (Electronic Medical  Records) are an absurdity.  They’re inoperable,  are user-unfriendly, don’t connect to other EMRs, are hard to decipher,  fail to  tell the patient’s story, distract from patient eye-to-eye contact,  don’t  add to quality care, and waste the physician’s time and effort spent endlessly checking boxes .  

EMRs aren’t “meaningful,” to doctors and patients.  The “Meaningful Use” of EMRs, which requires doctors to follow  complex protocols to fill in boxes is absurd.

Don’t take my word for it.   Read these excerpts from two articles contributed to The Health Care Blog.

One,  “The only measurable change from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from  our time  with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives.”

Margalit Gur Arie, “Why Meaningful Use Has to Go,” The Health Reform Blog,  December 28, 2015

Two, “Dear Santa,

I’ve been a very good doctor all year. I have checked all my boxes and aced all my Meaningful Use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:
1) I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniature window.
2) I wish the patient’s next appointment date was displayed next to any incoming report I have to review.
3) I wish I could split my computer screen so I could see an X-ray or consultation report or a hospital discharge summary.
4) I wish, when I open a patient’s actual visit note for today, the place where I do my documentation, that I could automatically see at least the beginning of the latest of every category of information
5) I wish my EMR would know that prn medications, such as nitroglycerin, are not meant to be used for only a limited time.
6) I wish my EMR would automatically display the patient’s kidney function and allergies next to where I pick what medications to prescribe.
7) I wish my EMR wouldn’t alert me to drug warnings and interactions that are too obvious to need reminders for.
I’m sure if I tried, I could think of an even ten wishes, or maybe even twelve – one for each day of Christmas. But these seven things illustrate the underlying, fundamental wish I have: that my EMR will evolve to be more user friendly. I wish, now that the basic functionalities of EMRs are in place, that somebody comes back to people like me and asks how to take this thing to the next level."
Hans Duvefelt, MD, All I Want For Christmas: Seven Things I Wish My EMR Could Do,” Hans Duvefelt, MD, December 19, 2015


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