Monday, August 19, 2013

EMR's : Good or Bad

Over on GregSmithMD, Dr. Smith talks about the downside of Electronic Medical Records: Thing one: they distract the doctor, Thing Two: They take a lot of time and decrease free/casual/down/recharging time for docs, Thing Three: Some older wiser therapists opted out and retired, taking their talents and the institutional memory with them.  Dr. Smith also points out that it helps to have legible notes.

As I've mentioned, I left my job at the clinic where I've worked one morning a week for the past 15 years because I couldn't deal with learning the new EMR, see My Epic Meltdown

So never mind the fact that EMR's require that doctors collect all sorts of information with each visit which may or may not be relevant to the patient's care.  Treatment becomes a checkbox from a drop down list.  The screen sucks time and attention.  But I have a different concern.  When I go to a doctor, I ask for a copy of the consultation note.  I keep copies of my labs, copies of notes from any specialist I see, results of any test I have.  I've been struck by how these notes contain gross examples of inaccurate information.  So far, nothing I've seen has been scary, but there's the documentation that my liver and spleen are normal in size by the doctor who didn't check (maybe X-Ray vision was involved).  And I really like how I'm "currently married."  Does that imply that it's a temporary state?  I've been with the same guy since I was 18, at this point I'm thinking it may last for a bit. Okay, I'm nitpicking. None of this matters, and I avoid docs with electronic records, so mistakes hopefully don't get transmitted.

Here's my question about Electronic Records:
~ Don't they risk that misinformation will be perpetuated?  Isn't this dangerous?  Shouldn't patients review the records to be sure they are correct?  Why aren't we more worried about this?
~Don't they increase the physician liability?  If a doctor writes something in the record, even a note from a phone call, and this contains important information, and these charts quickly get full of information because every phone call, every visit with every healthcare professional (including phone calls requesting refills taken by a nurse) is a separate note, isn't each physician responsible for knowing what's in all these now-legible notes, and if something gets buried in one of many notes and the physician misses something important, isn't it now an issue?  Patient calls and notes they developed a rash with a medicine.  Doctor puts it in a phone note, but doesn't record it in the allergy section and forgets at the next visit.  Patient later has a bad reaction when given that same medication a few years later.  

Okay, so what have your experiences been to date with EMRs?  Good, bad, happy, sad?


Anonymous said...

People seem to think that computers are perfect. The reality is that they are only as perfect as the data that an entered (and occasionally, they burp losing ALL that data and creating havoc).

Yes, misinformation will be perpetuated. That has always been a risk but it is heightened with an EMR, especially since some systems are so unwieldy w.r.t. correcting errors. Yes, there is supposed to be a "trail" to document, but it makes it very hard.....

On a bad day, when I am feeling paranoid, I am convinced that EMRs were created by 1) lawyers -- the EMR creates a rich data environment to harvest for lawsuits and b) the government/insurance for data mining, not necessarily to the patient's benefit. Because of HIPAA constraints, the EMR has done nothing to facilitate exchange of information.

As a physician, the mental drain of trying to click all the right dots, sign off on all the pieces of data, see has created a sense of exhaustion that never ends. Our office has an excellent EMR, but with that, I would estimate that the time for processing each patient is increased by about 15%, although I am seeing the same number of patients that I saw previously. It just comes out of MY time. Our hospital has a horrific EMR. Right now, we are in a hybrid system. With that, my time for seeing each patient is about 30% greater. I anticipate that unless the hospital is willing to invest in a better system (or the system gets upgraded), the time to see each patient will double. I doubt that will ever happen because the entire medical staff will probably revolt.

Joel Hassman, MD said...

PPACA is going to enforce the use of EMR. Gee, you think that is an agenda in and of itself?

If providers do not see the dark side of what this legislative onslaught is going to do to health care in general, mental health care specifically, well, how does the earth look with that head buried in it?

Dark and dirty, eh? Sums up the purpose of health care designed by politicians and bureaucrats. Hey, just my opinion. You all trust a man who can't even be consistent with a serious matter like Egypt?

And he was the force behind this transformational change in health care. Wow, we are not doomed, we are done!

But, partisan agendas must be maintained, so don't let me get in your way, folks!

PsychPractice said...

I heard a revision to the old Computer Science adage: Garbage in, garbage out.
It's: Garbage in, gospel out.

Ann said...

Only addressing one point - doctors, like all people, make mistakes. When I was hospitalized and received a discharge report I was shocked to see the bizarre mistakes in it. The doctors were not using an EMR, just regular notes during conversation. It happens with and without EMRs, because drs are not perfect.