Monday in FierceHealthIT, I reported on safety issues related to poorly implemented CPOE systems, and briefly mentioned one downside to EMRs in general, courtesy of New York Times columnist Dr. Pauline Chen. Today, I'll go into some more detail.
One problem with EMRs that often gets overlooked is perhaps the most obvious element of all: there's a computer in the exam room that wasn't there before.
"[A]s I settled in to see my first clinic patient, I realized I had no idea where to sit. The new computer was perched atop a desk in one corner of the room; the patient sat on the exam table on the other side of the room. In order to use the computer, I had to turn my back to the patient as I spoke to him. I tried to compensate by sitting on a rolling stool but soon found myself spending more time spinning and wheeling back and forth between patient and computer than I did sitting still and listening. And when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent," Chen writes of her first patient encounter using an EMR several years ago.
"My vision of an interaction marked by the seamless flow of conversation and capture of information vanished. Instead, I was spinning my wheels. Literally."
Her discovery? An EMR may improve data flow and access, but it doesn't guarantee better communication for physicians with their patients and fellow health professionals. Chen cites a recent Center for Studying Health System Change report that concluded current EMR systems aren't all that good for care coordination.
My feeling is, EMRs are fine for care coordination--if they're designed to be user-friendly and if doctors actually use them properly. (See also: "meaningful use.")
I hearken back to HIMSS09 in Chicago. I slogged through that busy week with a case of bronchitis. I tried treating it with over-the-counter medications and chicken soup, to no avail. By the final day, I couldn't take it anymore. I called my internist's office and made an appointment. (I may be the only one grateful that HIMSS met in Chicago during that snowy week.)
My regular physician was off that day, so one of his partners saw me. This just happened to be the tech-savvy partner, the one who convinced the others in the practice to invest in an EMR, a Sage Intergy system, several years earlier.
The problem was, he was the only one who relied on the EMR and took the time to enter data. I found this out when he pulled up my record on the desktop computer in the exam room. My record was essentially empty, save for insurance and demographic information. I'm sitting there, while coughing up a lung or two, having to recite my current medication list for this physician while he meticulously typed in this information.
Doctors didn't go to med school to be typists. I did tell the doc I was a health IT reporter, and I asked him about the Intergy system, so perhaps that's why he took the time to enter my med list. Or maybe he was trying to help his colleagues by demonstrating the value of an EMR. Either way, it was an eye-opening experience about how many physicians see EMRs as a distraction rather than a useful tool.
I left the office with a prescription. Written on paper. - Neil