Sunday, July 14, 2019

Do Patients Like Electronic Medical Record Systems?

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.  Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.  Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.  But, keep in mind that these systems were not devised and implemented because physicians demanded them.  To the contrary, they were designed to simplify and automate billing and coding.  While this made their tasks considerably easier, it was at physicians' expense.  Features that helped billers and insurance companies didn’t help us take care of living and breathing human beings.   It made us focus on silly documentation requirements in order to be fairly reimbursed.  And, it offered very clumsy mechanisms to record a patient’s history – the story of your symptoms – which is our most valuable piece of medical data.  You simply can't click your way through a patient's narrative. 

Admittedly, the process is much better now than it was a decade ago.  But, it cannot replicate the experience of pen & paper when physicians could use eye contact, facial expression and nodding of the head during office visits.  Indeed, this is how I practiced for the majority of my career. 
A recent job change has given me the pleasure of learning a brand new EMR system.   Learning a new system has been like a undergoing colonoscopy – uncomfortable but necessary.  I wonder how many hundreds of clicks I perform each week as I navigate through a system that seems to have no boundaries.  While some of my colleagues use voice to text technology, or have a scribe shadowing them, I rely upon my 10 digits tapping across the keyboard to get the job done.  And, since I worked as a typist prior to becoming a gastroenterologist, I can look my patients in the eye while typing.  (Interesting that a typist and a gastroenterologist both need to be digitally skilled.  Perhaps, in my retirement I will study piano?)

Pre-EMR Technology

I wonder how the EMR arena has been for patients.  Please share your experiences here especially if you are old (ancient) enough to be able to compare current click medicine to pen & paper documentation.  How has your office visits changed?  Do you think EMR has changed the doctor-patient relationship?  Share your frustrations.  Let me prompt you with Frustration #1.  Why don't all the EMR systems communicate with each other?  Why is this promise still unfulfilled?

Using the ubiquitous rating system, how many stars would you award the EMR experience?


  1. I'm an RN who has been around a while. As a patient I have left verbal messages for providers. More than once this has required more than multiple contacts with the office straightening out the miscommunication caused by the "game" of "telephone".

    One of my current providers is very proficient with his EMR. I am able to message him through the patient portal. He responds when he has time, and I do not have to re-explain my problem/concern. I love that.

    I also like being able to look at my labs through the portal.

    I know that not all patients my age are computer proficient, nor even many younger ones. I suspect that more patients would be willing to use a patient portal if they realized that it would improve communication.

  2. I like being able to see my lab and test results on line. Of course, I would prefer my former internist. He stayed in a solo practice and does not use EHRs at all. He sat for 20 minutes in his office talking to me before I went into the exam room. Looking back on him, I marvel at how quaint that seems. I trusted him and I second guess my current docs because visits are short and they rarely just sit and talk. They look at the computer rather than me. I still don't understand when to take my lasix or how much to take. There isn't time to ask or understand the answers.

  3. Thanks @anonymous. I have never had a colleague complain about my medical documentation. No physician has asked me to offer more details on my medical histories or physical exams. Indeed, since I completed my training decades ago, I have not rec'd any supplemental instruction on these 2 critical pieces of medical documentation. However, every year I am coached and critiqued by medical coders and billers on various lapses in my documentation. Need I say more?

  4. @Joan, thanks for the comment. I'll see you and raise one. Nurses on the hospital wards are practically welded to their mobile laptops, which they are pushing down the hallways. I suspect they spend more time with them than with their patients, and not because they want to.