The sad state of EMRs?

The sad state of EMRs: How they are doing more harm than good

This was a post I read on kevinmd.com, by Val Jones, MD.

Very thought provoking article. I tend to agree with his views particularly when it pertains to hospital settings because there are so many moving parts. Unfortunately, these tend to be islands of automation. Technology with 'bridges' tend to breakdown, because true integration is not there. Transcription, is one case of a disjointed system, and as Dr. Jones points out, it is one area where things can and will go wrong.

In an ambulatory setting however, things are slightly different.

I was with a Cardiologist in Delaware last Friday, and I saw how he was using technology. Here is a synopsis of what I saw.

  1. Patient comes in, MA updates medical history, takes vitals, initial review of system including the reason why patient is here (Chief Complaint). All of this is done in the EMR.
  2. When Dr. is ready to see patient, with one click, he sees what MA has done, as well as prior visit notes ( if this is a repeat patient).
  3. In the Exam room, he has a computer with a dual screen. The second screen is a large monitor attached to the wall. As he is talking to the patient, he is pulling up relevant parts of the chart so that the Physician and Patient are seeing the same thing. So, the actual interaction was a mix of eye contact and both the provider and patient looking at the screen while talking. He said the entire objection of 'doctor looks at the screen and not at me' is gone because doctor is sharing the screen on which he is charting. This, according to him, had a side benefit of patients sometimes pointing out that they are no longer taking a medication that was on the chart, or pointing out something else and asking questions. Increase patient involvement makes them happier. Therefore, he is able to finish most of the charting accurately while in the exam room with patient.
  4. Once he was done with the patient in the exam room, he walked the patient out, gave instructions to his staff if any, and went to his office. Being that his was a 'cloud' system, the same patient chart was accessible in his office. So, he did something interesting. In his office, he clicks on the HPI area and starts talking to the computer (using Dragon Dictation) about the patient's 'story'. Then, another click and he dictated the plan for his assessment and diagnosis. This took 2 1/2 minutes only! He actually signed off the note right there.
  5. He goes to the next exam room for the next patient.
  6. Just 1/2 an hour after his last patient, he was done, and he leaves for home, all his notes for the day are done and signed.
  7. Because of this, his billers are able to submit claims the same day and helps with better billing efficiency.

I have to say that for this scenario to happen, he worked with the vendor to get a well oiled machine in place. In his words, "You can't get this efficiency with a free EMR", work with your vendor as a partner.