Sunday, January 19, 2020

Electronic Medical Records - Broken Promises


I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog.  While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises.

Of course, EMR has brought tremendous advantages to the medical profession and we are all grateful for the technology.  But this progress has exacted a cost.  Many of them are clumsy to utilize.  When the technology breaks down or freezes, the office become paralyzed.  The systems are vulnerable to hackers who can exploit personal medical data or demand ransomware.  Many of the computerized notes  are so filled with pre-populated fluff carried over from prior visits, that it can be challenging to identify new medical information.  I often scroll through several pages in search of the physician’s thoughts and plans.  And a physician who is staring at a computer screen during an office visit will create a very different genre of a doctor-patient relationship. 

But here’s an EMR frustration that I am astonished is still torturing us.  In our digital era, different EMR systems cannot communicate with each other.  Indeed, one of the seductive promises of the EMR prophets was that physicians would have access to all of a patient’s medical data.  Imagine, for example, how useful this would be to an emergency room (ER) physician who is treating a sick patient who has been treated for the same condition elsewhere?

The Medical Records are in there somewhere!  


Every day in my office practice, I see patients with active conditions who have been treated by other physicians and at other hospital systems.  The patient before me with abdominal pain may have been seen for this in an ER a few weeks ago, and then seen by his own primary care physician days afterwards.  Shouldn’t I be able to have real time access to all of this data?  Wouldn’t this help me to make a more accurate diagnosis?  Might this prevent me from ordering an unnecessary medical test?  Is this vexing issue simply insurmountable?  ‘Is there no app for this’?

Patients are as frustrated over this as we are.   “Alexa, please get my this patient’s CAT scan report!”

2 comments:

PICU MD said...

I think the biggest problem is that the "customer" for the EHR is not the doctor or patient but the government and payers. If they started with will this benefit pts at the bedside and office visits and how will this improve the workflow of doctors and nurses we would end up with something different. If you look at the best apps they are laser focused on workflow and usability which is lacking in the current EHRs.

Michael Kirsch, M.D. said...

@PICU, spot on! Of course, the EHR systems were designed primarily to assist those who do not see patients. Any shock why actual practitioners find the systems to be clumsy and unwieldy? If, however, you are a biller or a coder - JACKPOT!

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