Why Electronic Medical Records Aren’t Being Used
About 20 percent of U.S. hospitals and 30 percent of office-based primary-care doctors — about 46,000 practitioners — had adopted a basic electronic record in 2010, according to government statistics. So why is that?
Such systems are hard to use and difficult to maintain. They disrupt clinical practice. They don’t increase efficiency and often don’t pay for themselves. They disrupt the doctor-patient interaction. And they are very, very expensive.
I fear that the current incentives — simple monetary carrots and sticks — that the government is trying in order to increase the use of information technology in the practice of medicine won’t work. Just as we have a patchwork insurance system in the US, we have a patchwork IT system as well. There are relatively few standards, tons of companies, and lots of failures. It costs too much, it doesn’t work as well as you’d think, and there are way too many avoidable errors.
This is by Aaron Carroll, an advocate of EMRs.
Aaron Carroll makes a point I’ve heard before. EMRs can disrupt clinical practice and doctor-patient interaction. Imagine going to see your doctor and his/her face is buried in a computer screen, while struggling to type in your symptoms, find the correct check boxes and pull down menus to record your interaction. This could also make it difficult for physicians to listen carefully when they are preoccupied with trying to fill in the blanks on the EMR.
Where EMRs work, it’s because it’s an integral part of the clinic’s business model. Telemedicine is an example. You’re not face to face so the doctor can listen while typing. Also, it’s worth the extra effort on the part of the doctor since a medical history is important for telemedicine.
Anytime I’m seeing a doc who uses EMRs, it takes one assigned person to fill out the information and enter it into their system. Is it a personnel saver or does it demand more manhours to manage?
Why do computers interfere so much with the clinical practice of doctors, but don’t pose a similar hazard to other professions?
Brian, if you have a complex tax situation your tax advisor does not use a computer to figure out how your affairs should be structured. Same goes for a complex legal situation.
Both will use computers to generate documents, fill out forms, and communicate, however. Same thing happens in health care which, in the US, is quite wired compared to the rest of the world. The difference is that ObamaCare forces EMRs on everyone whether they are needed or not. In many cases, people who would benefit from them already have them.
The rest of use do not need a cumbersome piece of paper that keeps track of whether we had a normal eye exam 20 years ago.
When I worked for a pediatrician, I found the first one to object to EMRs was the doctor, who didn’t like A) carrying/starring at a computer all day B) a dr./patient interaction which was eerily similar to a conversation with a texting teen, and C) the awkward discomfort caused by a technician silently starring at a patient as he/she reported what was wrong. (Plus the technician couldn’t distinguish critical and irrelevant info, so he’d try to record every word of every visit.)
Next to dislike it was the office manager because A) it’s expensive, B) it’s expensive, and C) it’s expensive.
Thanks, Linda. That makes sense, although I’m reminded of my mechanic who keeps the “electronic medical records” for my car on his computer. When I show up, he scans a bar code on my car and is able to immediately see what work has been done in the past, manufacturer recommendations, part numbers, prices, and schematics that show him the most efficient way to perform the repair. He e-mails me when it is time to change the oil or when Toyota recommends a new timing belt. To my untrained eye, this seems like a system that would benefit the medical profession.
If bodies were machines, it would. But they’re not – every single body has aberrations that require man’s rational capacity to analyze and synthesize sensed information.
The day we can plug a computer into someone and their body provides a readout from each system will be the day what Brian is talking about will be useful. However, patient perception would then be… irrelevant.
The source article was really interesting. The guy talked about his father building his own EHR system, which I think might be a key to problem. Why are we making the system so complicated? If this guy was able to build a system that functioned just fine 20 years ago, we should be able to build something similar today. But, we’re asking too much of the technology (compliance, billing, etc) and these require too many work-arounds to be profitable for doctors.
The EHR problem, to me, is indicative of the greater problems with medical care. Why is it that we can write down in 1-2 pages the problems the patient has, but we can’t put it in a computer? I saw a surgeon writing patient notes in a binder and then sticking it back up on a shelf. There is absolutely no reason that should not be entered into a computer.
Our medical system, like our tax code, has gotten too complicated. The fact that EHR’s don’t work is not, in my opinion, a question of technology, it’s a question of what we’re trying to do with the technology.
Mr. Carroll made a fundamental error in writing that “almost every pizza place I call has a functioning electronic record system”. The pizza place has a functioning electronic ordering and inventory-control system (as, I’m sure, does every health provider – because they charge for each input instead of for bundled services). But no pizza place keeps a record of what their customers want. (Some retailers do profile their customers, with loyalty cards and whatnot, but I don’t have to use a loyalty card when I shop there. I am free to remain anonymous at any retailer, if I prefer.)
The consequential difference is that the pizza places’ inventory-controls allow them more flexibility in dealing with customers’ idiosyncratic demands. Obamacare’s EMRs demand less flexibility in meeting patients’ unique demands.
There are significant reasons that surgeon didn’t enter those pages into a computer.
1. On paper, the doctor has a long list of boxes to check and lines to fill. They skip every one of them and only fill one relevant line or box. Computer programs often require more info than the doctor would usually provide.
2. Putting forms next to each other on a table is much faster than opening/closing window after window on a computer.
3. Recording data is mind numbing. Don’t forget this isn’t just a question of mechanical utility – doctors are people too.
The pediatrician I worked for filled out 3-4 forms for each patient and saw 65-80 patients a day. Without complications, that’s two to three hundred forms a day. Try it: go somewhere online and fill out a simple form 300 times for 6-8 hours. Tell me you’d go through all the work of having a high undergrad GPA, trudging your way through med school and enduring a residency so that you could work in data entry.
In our surgical subspecialty office, we began utilizing a ‘cadillac’ EMR about eighteen months ago. The time spent on medical record keeping has exploded for all involved (physicians, PAs, nurses and MAs). There is more information in there if you pull up a patient’s chart but it is questionable whether the quality or usefulness of the information is anywhere near as good as before. Part of this is the result of having assistants record the information (without filtering any of it). Part of it is the result of federal incentives through payment codes (E&M) which reward lots of extraneous documentation and as a result, are the way these EMR packages are designed. Bottom line is EMRs allow a lot of (potentially) useless information be collected, stored and billed for each patient without really enhancing the value of the physician visit. The cost of implementation and maintenance is not trivial either in terms of actual dollars spent or in terms of the diversion of physician’s time away from actual patient care activities.
Dennis, that’s exactly what I observed.
How often does a doctor dig through a file looking for his patient’s medical history? If rarely/never, then why go through all the trouble of making it readily available for every patient?