Atul Gawande is one of the best writers today, writing on the subject of healthcare, end of life issues and modern medicine in general. You likely have heard him on NPR. Finally, he tackles the aggravation and lost promise of electronic medical record systems (EMR).
EMRs have been viewed as a panacea by the medical community, primarily by politicians and government administrators lured by the promises of centralized control of medicine with rising costs of patient care, along with lawyers who are seeking to minimize risk of lawsuits. Add to that hospital administrators, many of whom have never had to fill in a screen of medical data in their lives.
From the medical practitioners I’ve talked to about EMRs they are frustrated with the level of work they have had to do to keep up and the difficulty of finding useful information in the systems. Some patients have lost their lives due to EMRs, as specialized practitioners enter data that is not easily found, and when a patient is admitted to an ER room, often these instructions are lost to the ER techs. Or, to be more precise, they can’t take the time to find them in the mountains of screens. Yes, because of EMRs patients that otherwise may have lived are dead. Gawande alludes to this issue in his article.
Once, physicians could dictate and have the dictation sent to India overnight for translation. They’d have it the next morning. Or they wrote notes that were good enough and ended up in charts where they could be found quickly.
We are now in the worse of all worlds. EMRs are not automated enough to actually save practitioners time. Because of the use of EMRs, the expectations that medical providers can do the work faster and better mean that funding agencies drive providers to work faster and see more patients. A PA I know would spend two hours after seeing over 25 patients a day, before finishing the work of filling out her EMR records. She was not reimbursed for this effort and she said it affected her home life as well. It’s a story I’m hearing from many practitioners. At some point in the future dictation will be perfected and finding data that’s critical to patient care in an emergency will be easy to do. Until then, providers will continue to burn out and leave the system, just at a time when we need them more than ever.
We encounter, in Gawande’s article, an administrator who claims that the EMRs are not for the doctors but for the patients. While it’s true that patients use these systems a lot, (myself included) the results that most of us get are simply lab results and some easy to understand notes from our providers. That someone would think that the patient is the focus of all of this is misguided and shows a lack of understanding of systems. The patient could just have easily have been given this information without the vast back end systems that affect every moment of provider time. Think I’m wrong? It’s the backbone of every app you run on your smart phones. They are small and customer/consumer focused. We create these systems all the time. Requirements? Just listen to the customer. No need for thousands of hours of input meetings and lawyers.
It’s time to demand better EMR systems, focused on the needs of the providers and patients, not the hospital administrators, the lawyers, government and private insurers and the like. It can be done.
With all that said, Gawande’s article is the best thing I’ve read yet that gives a clear lay of the land of the frustration that physicians are feeling about EMRs. Take a read.