Sunday, November 11, 2012

Electronic Medical Records Holds Doctors Hostage

Which of the following events is most traumatic for a practicing physician?
  • Your staff doesn’t show up because the roads are flooded, but the waiting room is full of patients.
  • Medicare notifies you that coding discrepancies will result in an audit of 2 years of Medicare records.
  • You receive an offer of employment by a corporate medical institution who will bury your practice if you do not sign.
  • Your key expert witness defending you in your upcoming medical malpractice case is incarcerated.
  • Your office electronic medical records (EMR) system suffers a cardiac arrest.
Tough choices, I know. Our office lost complete access to EMR for 3 days, and it wasn’t pretty. I don’t grasp the technical (doubletalk) explanation for the temporary EMR coma, but we were reminded of how dependent we are on technology. Our IT gurus were working tirelessly, but their adversary was wily and formidable. Finally, they prevailed, but I wouldn’t regard this as a clean win for us. We were hobbling for 3 days. The fried server has been rebuilt and now has reinforcements to insulate against another crippling assault.

Ink and paper never crash.

Luckily, our brains were still functioning adequately during these 72 hours. We hadn’t yet lost the ability to obtain a medical history without pointing & clicking. Somehow, we managed to obtain a review of systems without trolling and scrolling across our laptop monitors. Ancient physician techniques, such as maintaining eye contact and offering nods of understanding to patients, were effortlessly recalled, like riding a bicycle. I even prepared a few paper prescriptions, once I was able to locate a yellowed and tattered prescription pad. I hope the pharmacies will accept these medical anachronisms.

The tough reality is that during these 3 days we had no records available for the patients we saw. We compensated when we could, with faxes and phone reports, but this is no substitute for a complete medical record. Patients arrived to review test results that we couldn’t access. In some cases, I had faxed biopsy reports available, but not the accompanying endoscopy operative reports that were hiding in the EMR black hole. Patients were understanding of our dilemma, since many had faced their own computer rages. But, many of them did not receive a full measure of medical services from us. I asked some to return to see me for another visit, once the EMR was resuscitated, as I feared I may have overlooked some important issue during the 3 days of Stone Age medicine.

Karl Marx

To paraphrase, the most famous phrase uttered by the individual pictured above, technology is the opium of the people. We love technology. We demand it. We upgrade it. And, we are hooked on it. Like any addiction, when the fix isn’t there for us, withdrawal is painful.

I’m thinking of opening the first chapter of Techno-Addicts Anonymous. Of course, the first step of recovery is the toughest. “My name is Whistleblower and I am a…”


Anonymous said...

It is very likely that your patients got better care than when the computer ruled all.
Looking at the patient seems to be a lost art. Listening dissapeared ages ago.

Johnson said...

I have been completely read it.
That was very interesting.
Medical Record Review

Mark Faasse, MD said...

There is a lot of unrealized potential in EMR's. I can't understand why their usability remains so frustratingly suboptimal - do these software companies ever talk to the docs who USE their product? Even just taking the best parts of several EMR's (e.g., PowerChart, CPRS, and EPIC) and putting them together would represent a huge step forward. On their own, I'm inclined to say that they all stink, to varying degrees and in different ways.

Anonymous said...

My (ex)doc didn't know how to access past records. If it wasn't in his memory, the info ceased to exist. When I would remind him of my history, he would first get flustered with the computer and then angry with me. (He was in his late 30s. I might have expected that from an older doc.)

Michael Kirsch, M.D. said...

Very unusual that a young physician is a computer clod. I think you can estimate a physician's age by his enthusiasm and skill with EMRs. Perhaps, he should hire is teenage kid as his office IT pro.

Joan Price said...

This isn't a problem with the electronic medical records software. This is an issue of technology education. Servers may get fried, but data should be backed up and/or held in a cloud server. I realize EMRs are burgeoning, and we're in the middle of a learning curve. There are ways to ensure you do not have to go back to the "Stone Age" of medical documentation.

Michael Kirsch, M.D. said...

Thanks for your comment, Joan. I hear your point. There are almost no physicians who believe that EMR has made their professional lives better. For most of us it is a series of hassles and frustrations that make us less efficient, despite its advantages. Until voice activation becomes operational and widespread, the quality of the templated consultions and progress notes is inferior. The systems are designed to streamline and expedite billing, coding and clinical documentation - not primarily to increase medical quality.

Jamie Salcedo said...

Joan's comment is on the money. There are new ways like cloud services that can be used as a backup. Also, it will be important for healthcare training to evolve past just a point/click/type skill set. Great article, it was thought-provoking.

Anonymous said...

Paper records DO CRASH. After hurricane Katrina in New Orleans, thousands of paper medical records in doctor's offices turned to mush in the flood waters. Many, many people have no medical records before 2005 to this day as a result of one-of-a-kind paper records disappearing that way. Electronic records are not going away and docs need to get over the righteous indignation.

Docs managed to adapt just fine when electronic BILLING came along a few years ago.

Brielle Franklin said...
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