Making EMRs Work

Scribes are finding their place in emergency rooms—having concluded that entering the data into an electronic medical record can often “take as much or more time than dealing with a patient,” a St. Louis area hospital has hired scribes, at $8 to $10 an hour, to record patient responses to physician questions. A physician interviewed in the article reports that this is a winning strategy because he can “spend more cognitive time on my patient rather than finding what box to enter this information in.”

Comments (11)

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  1. Larry C. says:

    This does not surprise me. This is what happens when you force technology on people who see no need or benefit from it.

  2. Devon Herrick says:

    Doctors have told me EMRs create a barrier between the doctor and patient when the doctor has his or her nose buried in a computer screen, typing on a keyboard rather than facing the patient when talking.

  3. Neil H. says:

    Ditto Larry’s comment.

  4. artk says:

    Sure, at one time, executives refused to use computers. They would dictate e-mail their secretaries would send out. They refused to query systems directly to pull operational or financial information. They would write down what they wanted and an admin would look it up. Any executive who did that today would be toast. Who of you would put up with a bank or brokerage house that used paper record? And the Luddite excuse of its different is just bs.

    That’s what will happen with EMRs. Doctors and the NCPA should stop bitching and working to make the perfect the enemy of the good. Just get with the program. Use what’s out there now, it can’t be worse than the room after room of paper records that overflow the filing cabinets in any hospital or medical practice. The upgrade next year will be better and the upgrade the year after that will be even better. In 5 or 10 or 15 years it will increase productivity and quality to an extent no one can imagine today. That’s how technology works.

  5. femi says:

    “Dr.Watson” is coming, for sure. Best get with the program.

  6. Virginia says:

    I don’t blame them for hiring people to enter answers. My latest annual visit included 15 minutes of questions that had nothing to do with me. My doc had to enter “no” into each one of those categories. What a total waste of her time!

  7. Linda Gorman says:

    artk–the US arguably has the most wired health care system in the world, especially in places where such information matters. Forcing electronic medical records on people who do not need them is another thing entirely, especially if it wastes physician time.

  8. artk says:

    Well Linda, you can argue anything you want. But its simply not true. On factoid, Duke University Hospital has 900 beds and 1300 billing clerks. We have the least automated least connected least efficient medical care system in the known universe. All this nonsense about how various IT enhancements in health care will lower efficiency is just that, nonsense. Nothing could make our health care system less efficient than it is now. All the objections are just financial interests who know the transparency effective information systems will expose will force them to be more efficient. No other industry can get away with the inefficiency of our health care system.

  9. Will Blackwell says:

    Working in the medical field directly with patients, I find EMRs highly efficient. I can access information quickly, information is legible, I can access information from prior visits etc. Physicians are at least reasonably intelligent. Why do they struggle with technology? I find this concerning. Do you want your surgeon struggling with robotic surgery? Physicians only embrace new technology only if it benefits them directly. What about the benefits for the patients such as flagging patient charts for reminding physicians to monitor important clinical parameters. Flagging charts for unnecessary tests. Doctor it is time to come back to earth, remember why you are doing what you are doing and for whom.

  10. Linda Gorman says:

    Artk, Jos Aarts and Ross Koppel disagree with your assertion about the US lagging in health IT in a 2009 article in Health Affairs on computerized physician order entry systems.

    As for billing clerks–how does their number inform us about the utility of electronic medical records?

  11. David Lowther says:

    i notice no one above is a physician commenting on the EMR. artk and will blackwell have it all wrong.

    EMRs have nothing to do with patient care. the EMR is being set up to bank personal data centrally, ostensibly so that (who?) someone can use that information to judge utility. there is no efficiency benefit. like someone mentioned above, the time spent entering the data is all consuming and patients aren’t willing to wait through it. they’ve told me they’ve left other physicians that spend their time asking questions while simultaneously staring at a computer screen to enter info. you’d have to NOT be a physician to anticipate this as anything but bad.

    sure, we need a way of sharing information. now, we have fax machines, emails with PDF, etc. That serves the purpose of getting requisite information to the practioner. what the EMR advocates are screaming for has nothing to do with sharing information that helps clinical decision making. it has only to do with data banking. this in no way translates to better patient care.

    case in (obvious) point: the VA has a pure data base driven EMR and has for years. you pop up in new orleans with a condition and you’re typically followed by the boston va? well, query the VA system for the guy’s health recored (EMR) and voia! within a few minutes you have the guys full medical record…big deal! anyone that has served as a physician will tell you: the VA healthcare delivery is substandard (unfortunately – and speaking for the mouth of a son of a vet) at best.

    efficient medical record delivery has little to do with moment-to-moment clinical decision making as a physician. you’re still on the hook for whether IN THIS MOMENT you need to make a decision that may save a person’s life. rarely do you simply trust someone else’s decision, regardless of what information comes with that patient.

    the EMR is a tool of the government and insurers to track utilization and regulate the flow of information in an effort to “save money”. great intentions but little utility to the individual….

    …..unless society is willing to waive the liability of physicians for decisions made preceding their visit to THIS physician.

    if the EMR were desirable to docs, it would have been here by now.