Scourge:
- An instrument of punishment or criticism
- A cause of wide or great suffering
- Whip or Lash – especially for torture
Introduction
They say you never forget your first time. I remember mine, vividly. If only I could erase the memory. I had high expectations and higher hopes, but what I got was disillusionment. I felt violated and humiliated. I’m talking about my first time using a system for electronic health records (EHRs).
Early in the transition to digital records, our clinic for the under served purchased one of the pioneering electronic health records systems. “Primitive” doesn’t do it justice. There was one central transmission tower for multiple buildings in different parts of the city. The system was operable only during office hours. A high wind could render it useless, indefinitely. We prayed for a tornado to selectively carry away the whole damn thing.
Each of the physicians was given a little computer to carry around as we worked. I mean little – about 4” x 6” (Excuse me! 10.16 cm x 15.24 cm.) The mouse was right in the center of the keyboard – the size of a BB. If I called something a cyst, and you called it an abscess, our records would never speak to each other.
Expectations
At the beginning of the change to EHRs, both physicians and patients were excited by their potential. Some of the features physicians looked forward to included:
- No more wading through thick paper charts.
- No hunting for test results.
- No scrambling for letters from consultants.
- No more wondering if dictations would make it back to the chart by the follow-up visit.
It was most appealing and important that EHRs would allow physicians, consultants, hospitals, other providers and facilities to readily exchange information without delay, when delay could mean disaster.
Problems
To improve efficiency, the EHR concept was highly favored, but the execution just doesn’t deliver. Physicians describe some of the problems, including:
- Decreased face-to-face time with patients
- Inability for systems to interact
- Time-consuming data entry
- Distracting physicians and patients during office visits
Potential solutions
We can’t go back to simpler times. EHRs are here to stay. What’s the treatment for this affliction (AKA torture)?
The consensus among users is that what is needed most in EHRs is interoperability. The Healthcare Information and Management Systems Society (HIMSS) has defined interoperability as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.” Interoperability opens the way for many new digital tools — such as apps for both physicians and patients — to make data-sharing among EHRs a priceless asset, not a source of frustration.
We need access to patient records in EHRs from different systems. This type of communication was one of the fundamental lacks that the transition from paper was meant to remedy. The issue, unfortunately, is commercially driven lack of cooperation, not lack of technology.
Achieving interoperability among EHRs will allow for remote monitoring of cardiac activity and the use of other devices which supply information, such as patient activity levels and fitness. Patient and physician interoperability will also facilitate and add value to telemedicine encounters.
At my annual well-woman office visit, the nurse first asked me the usual questions, collected history, and validated previous information. The whole time (considerable), she sat with her back to me as she made entries into their officce EHR system. I couldn’t tell you her name or describe her appearance. Although their program demanded exhaustive information, if you said, “Tell me about Faith,” she could tell you my vital signs, and tell you that cancer runs in my family, but she couldn’t tell you who I am. It takes the care out of healthcare.
Remember Elizabeth Kubler-Ross’s book On Death and Dying? She proposed that there are five stages of grief: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance. What an excellent paradigm for this transition from paper to screen.
I wonder perhaps if there are superior systems out there that certain hospitals should switch to. Currently having been at hospitals in Baltimore using the system MedConnect and Epic down in Oklahoma, I haven’t noticed in the hospital setting the application of the ehr taking away time from providing quality patient care. Perhaps the system is different in family practice and also depends on physician capability? Perhaps time spent with each patient should be increased to allow for both. I have noticed at annual physical appointments my doctor is perched on the computer more so than back in the 90s, but I think the tradeoff for informed up to date clinical information is worth the trouble.
Hello Annya!
I think some of the newest EMR systems are a lot better than they used to be, but their are definitely many hospitals and clinics out there stuck with systems that have a lot of flaws. One of the biggest flaws is the lack of interoperability that Dr. Coleman talks about in her blog post. Do you know whether or not the two systems you mentioned would be able to share patient records with each other?
Hello Michael!
I know MedConnect links all the MedStar hospitals in the state of Maryland (10 in total), so that if a patient was seen at one, it could be accessed at another smoothly. And if not, the communication between the different locations is very fluent so that gaining access through other means occurs very quickly. They have two systems in place as well, if the patient hasn’t seen a doctor in 5+ years their old information gets stored on a system called Oscar for older records which then can be accessed by all MedStar employees on the same computers.
I agree that better integration needs to occur between different EHR systems, since it would be difficult to obtain records on a patient that recently moved to Maryland from another part of the country. But a quick phone call can always solve that problem.
As you said not all EMR systems are equal and efficient. And I am unfamiliar with the process of hospitals selecting which EMR system they use, but I suppose that lies on the CEO and other members involved in the finance of it all.
Thanks for explaining that Annya.
Before I go into the healthcare recruiting business, and then the job board business, I had a job with a company that was involved in ROI (release of information) for medical records. That was back in the days when EMR had been mandated, but the implementation date was still in the future so I got to see a lot of the early systems, and to learn about what was required in order to switch over from paper. Anyway, I agree that there are many hospitals that need to make a change, but I’ve also seen how big of a commitment (financial and otherwise) many of them have already made to flawed systems and can understand reluctance on their part to switch again. Especially if their reason for not adopting another new system is they may be waiting for better technology to address the interoperability issues that prevent EMRs from functioning as many wish they did.
Also, I hope you’ll blog for us again sometime in the future! Feel free to get in touch anytime.
That’s very true. Thank you for that extra insight Michael!
Definitely!
Great article, Dr. Coleman! You are still an amazing writer! I wonder
if things will get better or worse as voice interaction with computers
improves and takes over the keyboard interface. It seems like that will
allow better interaction with the computer recording on the sideline.
Somehow, though, those technology promises never seem to quite
materialize – just as you discussed here…