Even though many doctors complain about the EMRs, more and more people in health care are making the change, either by choice or by necessity. A 2014 report showed that in 2013, 78 percent of office-based physicians had adopted some form of EMR system, and 48 percent of all physicians had an EMR system with advanced functionality––double the adoption rate in 2009."Another major problem is that individual EMRs don't automatically communicate with one another. It's like using a key to a different car."
You are going to get a lot of people at the ends of the spectrum—you're going to get a lot of people saying they are no good and useless, and other people finding them useful. It depends how well they've adapted their practice to using the EMR. Once you get used to it, some doctors find that in general it can make life easier. The bottom line is, though, if you own your own practice it is going to increase the cost of care. There might be an improvement in quality of care, but for sure it is increasing the cost of care. I don't think anyone is going to argue that fact.In general, I think EMRs are useful. I used to be in the Air Force; they have a global military medical record system. It is a cumbersome system but it does achieve the ability to access someone's medical record electronically anywhere in the world. I don't think we'll ever get to the point where we will get people's medical records on one system, but there is a lot of data that has to be collected in terms of lab values and diagnostic studies and things of that nature."There might be an improvement in quality of care, but for sure it is increasing the cost of care."
There are also people like me: I'm 46, I trained in the era before EMR, and I there are so many good things about EMR. Many things are easier now: we don't have to go down to radiology to look at CAT scans, you have all the info in front of you at the click of the mouse.One of the concerns I have is that the computer is interfering with patient doctor relationships. Doctors are becoming more separated and disconnected. When you are seeing a new patient, you can just look at the note somebody else wrote and copy and paste. Sometimes erroneous info gets propagated from note to note. There are these perils to EMRs as well.There is one dominant platform called Epic. We need to ask the leading manufacturers to work together to solve this problem of why their systems dont talk to each other––there must be a way to bridge all these different systems. There are too many different silos.Richard Weinstein, MD, MBA, Orthopedic Surgeon, White Plains, NY: VERY BADEMRs in their current state are very bad. I think there is tremendous potential for them to be good, helpful and improve health care and efficiency, but the way the government is mandating them and the way they're currently being used, they're very bad.I've used several EMRs and I'm currently partially on one of the EMRs called NextGen—I was previously Athena. So I have quite a bit of experience using different systems."Some people are actually retiring early because of this, because they're being forced to change to EMR."
It makes seeing patients very ineffective, it slows me down dramatically, it does not improve the system at all. It is of absolutely no benefit to patients––and not only does it not benefit doctors, but it hurts doctors. It forces them to allocate time, money, and resources into something that doesn't benefit our patients. A key of good health care is to provide a value product—to get patients in quickly, out quickly. But most of the government regulations slow us down and prevent us from what we should be doing, which is spending more time with patients.Athena was designed to make the health process more efficient and work better. Overall it's designed to make things more efficient. NextGen is designed to meet government requirements. Most EMRs are not designed with the doctor and patient in mind, they're designed to make it searchable for numbers and data by entities that want to control what we do.In my opinion the government has never proven it is able to help the private sector to be more efficient or be better for patients. Medicare is going bankrupt. There are EMRs out there that can help doctors."Most EMRs are not designed with the doctor and patient in mind, they're designed to make it searchable for numbers and data by entities that want to control what we do."
Now hospitals are being forced to hire scribes because people are spending so much time typing. If you think of a small emergency room, that has 12 doctors in a given 24 hour period, they are now hiring a scribe for earch that follow the doctor around and write down everything. that means 10-12 scribes per day, and each is getting around $40,000 a year plus benefits. How is that saving money? And who is paying for that? It's the taxpayers."I've seen cases where the patient is dying on the table, going through anesthesia and in the Pyxis EMR system you have to go through a series of passwords to get the drug out, and it isn't working."
I think it really cuts down on quality of care and time you can spend on a patient, and the number of patients you can take care of, which is bad because we have a doctor shortage right now.Mike Zalis, QPID Health co-founder and CMO & practicing interventional radiologist at Mass. General Hospital, Boston, Massachusetts: GOOD, HOWEVEREMRs are necessary, and so I would say they are "good." We need health care to join the digital age and EMRs support communication among patients, providers, and other stakeholders.However, they were designed for a wide range of administrative and clinical functions—much like the enterprise resource planning (ERP) systems of the 90s—and rammed in at a rapid pace. So some of the unique requirements for specific users are missing and the interfaces are clunky. The opportunity now is for solutions that enhance our ability to leverage the information in EMRs for quality improvement and communication.There are several main issues clinicians face. One issue is that there's been an effort to make all EMR structured—the potential value is that if you have structured information, like a text box or pull down menu, there's a very precise, crisp clarity as to what is meant by the choices you can select. The trouble is in practice, people don't think and don't tell their clinical stories through checkboxes and radio buttons. That's not how people operate. That's true for patients and clinicians, there's a lot of nuance that is lost when we structure it this way.Meaningful Use is the most asinine thing in the world. It is a regulation that absolutely cuts into your practice, and it is so time consuming, and so ridiculous, and does not improve patient care. You have a bunch of attorneys in Washington who know nothing about medicine deciding what is best for patients.
Another thing clinicians say is two major items: The medical record of each patient is growing rapidly each year—average patient record grows by about 80 mb of data per year. That becomes a lot of info, and the end result is clinicians spend more and more time having to sift thru larger and larger pile of data to find those key pearls that allow them to see the patient in context of how they are right then and there.Also, clinicians are spending more and more time on the computer. It breaks the clinician patient relationship. If you aren't feeling well, you want to see eye contact, physical contact, the sense someone is really listening and keyed into how you're doing. If they are looking at a screen they seem distracted.The final piece is that the public appropriately is demanding greater accountability for the huge amounts of money we spend in this country. We spend 17 percent of our GDP on health care and yet our outcomes are no much greater than countries that spend less. Appropriately the public are all demanding and increasing an agenda of quality metrics to measure care and how we do care and quality and safety of the care we deliver.In general, clinicians see EMR as a necessary thing that's in a primitive status. It's good to have things in an electronic form––it's better than paper, but the current form is primitive, time consuming and clunky. I'm a geek so im sort of open to these kinds of digital changes, but I can understand someone comfortable with doing things their way finding EHS systems to be overwhelming."In general, clinicians see EMR as a necessary thing that's in a primitive status."
I see all the time nurses taking care of a patient who don't know anything about the patient because they're so busy putting in data, and that isn't one brand of a system over another, that's just the nature of the system. I call it the hourglass effect. When you're looking at a computer screen instead of waiting on the patient, that cuts into personal care.The system is very flawed. I think it can work in certain instances and not others, but I think the biggest flaw is the fact the government is dictating it. I don't think the government does a good job of running its own business let alone businesses it doesn't know anything about. That is affecting the care people in America are getting. EHR are just part of that. I have friends who are just opting out and taking the financial hit and I know people who are retiring far earlier than they were planning to originally. There is going to be a shortage of doctors in America when that happens."I see all the time nurses taking care of a patient who don't know anything about the patient because they're so busy putting in data."
A lot of older physicians were very comfortable with the paper system or dictating. When you introduce EMR, the way the work flow for many EHRs is that the physician is doing all of those things, the things he or she previously delegated to someone else they are responsible for now, like for entering the order, the diagnosis, the medication. They're upset about having to do something they didn't have to do before, and they're finding it less efficient.There's no question for many physicians the advent of EHR has meant more stress, doing things they didn't do before, but there are a lot of benefits. I've been in practice for more than 20 years—it was not uncommon you couldn't find a patient's chart when they got to the office, or it wasn't updated in time. That is a really rare occurrence now because a patient can go this morning to the lab to get their blood test done and it will be in their chart by the afternoon. The information is there at the click of the button. When I'm on call, when patients call me the first thing I do is log onto their record to see what they came in for, their history, their allergies, etc. The media likes to fan the flame of negativity but there have been a lot of good things to come out of EMR.Dina D. Strachan, MD board certified dermatologist, New York City: GOODSaying you don't like EMR is like saying you don't like a sandwich. There are all types of EMR and it depends on what it does for you. If it makes your life easier, you want to use it, but if it doesn't, you don't want to use it.I found one that for the most part, it made running my practice easier. I was happy to switch to it because it was reasonably priced and it actually did all the things I needed it to do for it to be of service to me. It helped me streamline some operations, to address issues of joint charges. Billing was very easy. All of these things were super easy with the EMR I ended up using."We have young physicians who are very tech savvy and couldn't dream of taking care of patients in any other way because they've only trained with EMR and don't have experience with paper."
It's how an individual person interfaces with technology. There are EMRs where you type, and people who don't like to type won't like it. There are some with click boxes and I hate those, those are designed by people who don't practice how I practice. The bottom line is people don't want to use things that don't make their jobs easier.* Disclosure: The author is related to two of the doctors interviewed for this piece.Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here."Saying you don't like EMR is like saying you don't like a sandwich."