Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR). I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary. And it’s not a fair fight. You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence.
I have a competitive advantage over many other physician
contestants in the battle of Man vs Machine.
I can type well and can do so while maintaining eye contact with the
patient. You must think I am a magician
or a savant. While this may be true, the
birth of my advanced digital skills started decades ago. (As an aside, digital competence is essential
for gastroenterologists.) During college, I worked as a secretary for various
temporary agencies. Each one required a
typing test for speed and accuracy. I
plugged in my earphones and transmitted dictation into a typewritten
product on an IBM Selectric typewriter, a precursor to today’s voice-to-text technology.
Which matters more?
Knowing how to use a stethoscope or knowing how to type?
I did not contemplate then that my typing skills would
become an essential medical skill.
Without this ability, I would be hunched over the keyboard pecking away
with my eyes fixed on my fingers and not on the patient. Seem like a good formula for
patient-physician bonding? It
isn’t. Some physicians can work around
this with use of a scribe or using voice-to-text technology, but most of the
doctors I know do not use them.
If the EMR system goes down, guess what? I can’t work.
If a world class physician, a medical luminary, a doctor’s doctor, can’t
use a computer, could this doctor get a job?
EMR is a wily opponent.
Just when I might think that I am gaining ground on him, I am informed
that a software upgrade is about to be implemented. Think of this as a quarterback being sacked
30 yards behind the line of scrimmage on 4th down. All you can do is punt and surrender the ball
to the other side.
Undoubtedly correct, technically as well as philosophically. My hope is that electronic records ultimately add value to “the system” — by which I mean patients whose records can be more easily shared among physicians as well as humanity because AI crawlers will catch patterns in diagnosis and care that, over time, should be even better than one doctor’s memory from that one doctor’s experiences. Imagine after a doctor enters a list of symptoms and his/her diagnosis into the electronic record, an AI avatar pops up to ask the doc if he is aware that there are alternative diagnoses or treatment protocols? Not the mindless stupid shit that will annoy on day one because you clearly knew/thought about those alternatives, but the big data assessment capable of actually improving care. Luddites can reduce the pain by accepting the inevitable or taking on big tech. You have found the better course of (in)action.
ReplyDeleteI also can type very fast since my mom made me take summer school typing classes in high school. But even though I can type while maintaining eye contact with the patient, I cannot LISTEN nor THINK when I am transcribing what they say. The healthcare system requires you to interview the patient and transcribe at the same time, but IMO it is suboptimal.
ReplyDeleteAgree 100%!
DeleteThe premise is that the EMR is designed primarily to enhance patient care is SEVERELY FLAWED. It was built as a mechanism to capture charges and monitor work. Until the paradigm changes it continue to achieve the design goals and NOT patient care as the primary goal......
ReplyDeleteI am not a good typist, but I am a good listener. I leave my keyboard in my office and jot notes on paper for later in the day when I have time to do my charting. Yes, I am the last person to leave the clinic most days. I like EMRs because they make the record of a clinic visit very legible and easy to review. This is not only good for me but for any consultants to which I am referring patients. However, over the years, my position has allowed me to review charts of many providers and I have seen a disturbing recurring practice in which the provider uses a template designed to describe a typical visit and due to time constraints, fails to modify the template to address the patient's visit on that day. This can be interpreted as fraudulent and may severely attenuate the strength of a provider's defense in a malpractice site. For instance, an above the knee amputee does not have bilateral patellar reflexes, a patient with poorly controlled a fib does not have normal sinus rhythm and a patient with spastic quadriplegia does not have normal strength and tone. Let me be clear. I have been just as guilty. We all know that treating the patient optimally is paramount, but getting the record right is important too. Perhaps AI will help keep us honest.
ReplyDeleteI took typing as an audit class in summer at a community college between high school and first fall semester of college. No grade just coaching. The smartest move ever. My mom bought a typewriter that could backspace erase...great solution pre computers. Helped us type paper in an emergency. Bought the first computer in parts with home assembly because it was more affordable. 5 and a half inch floppy drives as well. Learned in dos until there was Java. Took class notes for pay as a notetaker in med school. Got paid to perfect my typing skills - win win win. Have been perpetually working on solutions to do typing less and templates more and dictating into text if essential. Most importantly remind myself that noone ever died from notapenia. Lets hope AI gets us out of 85% of the typing and dictating. Not everyone has the trifecta of hand eye esr coordination and communication skills
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