ELECTRONIC MEDICAL RECORD

In the beginning, there was paper and pen. The EMR (electronic medical record) did not exist.  Everything was written by hand at the time that you were in the office. While I often found it difficult to read my handwriting, what was important was clearly spelled out in block letters.  Documents, lab and x-ray results and assorted material resided in the chart on the paper they arrived on.  Charts became thick and cumbersome and to share them with other offices required either copying and/or mailing the records or faxing them.  There was a high cost incurred in managing those records (and the space needed to store them). This was the golden age of medicine.

When the EMR finally arrived, it promised to make life easier and lower expenses. It promised to streamline everything while improving medical care.  In essence, the EMR was a beautiful seductive whore that, while promising to make your wildest dreams come true, gave you HIV, Gonorrhea, Syphilis and a host of diseases not previously named and completely incurable.

I fell head over heels for her.  The first EMR we brought into the practice was designed by a programmer who quite literally went insane.  My love for my new EMR waned quickly as glitches pitted the programmer against the IT company.  Glitches often denied everyone access to the medical chart while money literally flowed out the window. You’ve heard the saying “in for a penny, in for a pound.” Well, this was more like “in for a penny, in for your life.”  Eventually, a second EMR came along promising to rescue us from the first.

The second EMR promised to be more friendly, more sophisticated and cost efficient and provide all kinds of nifty bells and whistles. I was no longer in love but not yet in the hate stage.  Once again, promises were not kept, and we went further into the rabbit hole.

True hate came with the third EMR.  It would not talk to the second EMR despite the promise that it would.  It did most of what it promised to do, poorly.

The EMR was supposed to store all of your information in one easily accessible area. All physicians’ offices, hospitals and other medical entities were supposed be able to easily share data. It was designed to share your valuable information with others who are important in your medical care but, unfortunately, it failed. Greed killed it as its creators recognized that they could sell patches that did communicate with other programs.

In the 4 years I’ve retired, the EMR has improved.  If you can remember all of your passwords for the many EMRs your docs use, you can actually access most of your records. As hospitals buy more practices and private practices come together in mega groups, several EMRs have become the clear leaders in the market place. While things have improved and the EMR is fulfilling its promises, other problems have developed.

Does the practitioner in the room with you look at you or the computer?  Is he/she listening to you while their fingers fly across the keyboard.  To get paid an appropriate amount, there are boxes to check; and, in some offices, it appears that checking those boxes is of paramount importance.  Several of my physician’s office do it right. The physician does very little computer input allowing his/her assistant to do the bulk of the clicking. More offices are installing kiosks, enlisting the patient in the click the box derby. In all the offices I visit, the computer sends out forms to be completed prior to an office visit. Ultimately, the patient will become better acquainted with his/her own history and medications if the patient agrees to input is/her information.

While I no longer hate them, I certainly don’t love them.  Simply put, they have become a fact of life. My only advice is that you do not trust them.  After every visit, review notes (on patient portal) for accuracy.  Mistakes in the computer notes are often copied from note to note, eventually becoming facts.

I’m computer literate and find the portals and kiosks difficult to deal with.  I wonder how the computer illiterates are going to do in the new world of medicine?

Today’s joke is funny, or is it?

 How many programmers does it take to change a light bulb?

None because it’s a hardware issue.