How frustrated are you by your EMR?
Monday, March 2, 2009 at 09:18AM 
At least three physicians told me last week that their practices' electronic medical record systems are a major source of frustration and decreased quality of life on the job.
Two of these physicians in different parts of the country mentioned that, whereas they used to be heading for home by 6:00 PM, they are now often in the office until 8:00 PM struggling to get all their charting done.
How can this be?
The EMR is being touted as the panacea for what is ailing the quality of medicine in this country. Just invest $42,000 per physician in hooking them up to an EMR and medical care will improve dramatically!
I have long been a theoretical fan of EMRs. They weren't around in the early 90's when I was in practice so I have no experience of them whatsoever. But they sound like a really good idea. After all, I run my business using my computer and really enjoy what I can accomplish with it.
So how hard can it be to use an EMR?
I respect the docs who shared their complaints with me. These are no slackers, but instead smart and hardworking people.
I am beginning to believe that many of the EMRs are clunky, unwieldy tools that interfere with, rather than support, the physician's work flow.
Yes, I get that with EMRs, you can "sift, sort and analyze the data from digital records, for example, to better manage the health of patients with costly, chronic conditions like diabetes and heart disease" (NY Times Feb 28th 2009).
February's Journal of Usability Studies has an excellent detailed article on Usability of Electronic Medical Records that highlights the challenges physicians face with their EMRs.
Physicians, indeed, find that EMRs take a long time to learn and often make them less productive. Physicians experience specific usability problems when working with EMRs that cause long training times and loss of productivity.
The article describes the different and often variable elements of work that make a typical day on the job for a physician, and up sums the problems up neatly, with a somewhat optimistic conclusion:
Obvious problems with EMRs, such as loss of productivity and long training times, have deeper causes. These stem from the complex interaction of highly skilled physicians trying to complete complex tasks in a challenging work environment with a complex and not always usable medical information system. Yet, by applying user-centered design in this complex environment, usability professionals can contribute significantly to improving EMR usability. Greater productivity and lower costs with better health care may yet be our destiny.
And this doesn't even get into whether all these EMRs can talk to one another, thereby creating our idealized interconnected national platform for sharing patient data and developing practice standards.
It's time those engineers spent a week in a doctor's office or hired practicing physicians as consultants and truly listened to what they have to offer!
What's been your experience?
Philippa Kennealy
For those of you techie-inclined entrepreneurial physicians who want to tackle a much-needed problem with EMRs, here's a handy overview of some of the challenges with EMRs -- a reminder that no matter how much moola we throw at health IT for doctors' practices, there are some bigger tigers to be tamed!
Philippa Kennealy
And just to remind us of the patient's experience of sitting in front of a physcian plugged into his or her EMR, here's an email from a reader who shall remain anonymous:
"Hi!
I am living in Washington state now and go to doctors who have EMR but aren't computer savvy and spend hours and hours trying to complete their charts at night.
As a patient the system is very unnerving. The whole time I go to a doctor he or she is looking at the computer and trying to type. They aren't really talking to me at all. They are just trying to deal with their computer screen. I had all my records transferred to my family doctor here only to find out that once they were entered into her data base she really didn't know how to access important things like my last mammogram or HgbA1C. She has to ask me when I had these and when they are due. Fortunately, I am a good historian and know what she is talking about, but what would a lay person do? I am also extremely worried about privacy. People hack into computers all over the world everyday. Also when I go to a doctor I don't want to have my medical records shared with the government, public health agencies, or any other entities. What ever happened to patient confidentiality? It doesn't exist anymore. I try to go to people who don't have EMR as much as possible as I don't trust the system and I hate to see a doctor who is only interacting with their computer for the entire visit."
Reader Comments (5)
Training was also not handled properly. Our trainer had only been working for the vendor less than a year. Thus, our learning curve and productivity suffered as a result.
Now, having said that, I think we made the right decision because the benefit of having an EMR does outweigh the drawbacks.
In terms of time spent charting, one can make the argument that completing a paper chart may be quicker than an EMR chart. However, the level of detail in the documentation of an EMR is much more comprehensive than if a doctor would fill out a progress note. More documentation does help one justify coding levels. And I’m not suggesting to unnecessarily increase document just to increase the level of coding. What I’m suggesting is that the EMR helps you justify a higher level because you have the documentation.
I think the biggest benefit of an EMR is for the staff. Before we had an EMR, we had stacks of charts everywhere. The EMR eliminates that problem. Everybody has access to the chart at anytime. You don’t have to wait for the doctor to complete the documentation or the RN to update the chart with labs. The chart is always available. Even from home with the proper security and connectivity. So, pulling charts and filing is not an issue. Which was very time consuming before we had our EMR. Our staff easily spent an extra hour a day filing charts. And the hassle of trying to find a chart that wasn’t in alphabetical order was a nightmare.
An EMR is not perfect. But the alternative is far more inefficient. My recommendation for someone looking into one is to get a good understanding of what the EMR is going to do for you. In other words, have the EMR vendor align your expectations with what the EMR has to offer.
Oh, and remember that an EMR is just like anything else; the more you take the time to understand it, work with it and tailor it, the more the EMR will give back in return. But it won’t give back on its own. Like a bank account. Except the currency is time. The more you put in, the more you’ll get back.
Brandon
@pediatricinc
Pediatricinc.wordpress.com
Most of the vendors have huge user groups that include providers and staff who use the systems so I am not sure why you think they don't? The technology is a little dated in some cases and most providers turn off the alerts and reminders that are supposed to add safety and efficiency to the systems. Some complain that they don't want to practice cook-book medicine but they also fail to admit that 50% of the time (in family practice ) people don't receive the current standard of care.
One challenge is that all of the talk about empowered consumers ends up with patients who suddenly think they know more then providers and show up with reams of print-outs with requests for unnecessary and often expensive tests.
The reason that the EMR's don't talk to one another is by design actually. The customer is often a hospital or a clinic that doesn't want to share or make it easy for a patient to go from one system to another. So the vendors allow the hospitals to customize the software and that breaks down the ability to share the data. In Oregon when a couple of hospitals discovered they would lose money when they were no longer able to run duplicate tests they opted out of a system to share the data. Until you link the financing system to the technology you will be hard pressed to find anyone willing to give the data up for free.
Once the CMS money runs out what is the business case to the provider or hospital to pay to maintain these very expensive systems? Kaiser has hundreds of people who support their IT and they don't provide any direct patient care and the staff jobs that could be eliminated (nurses often are the biggest road blocks to implementation once they realize that the lab results will by-pass them and go directly to the provider) fight them tooth and nail. The challenge isn't the technology but changing the workflow and putting patients at the center.