by Josh Herigon, MPH
I was in our family practice clinic today and couldn’t help but noticing once again that the electronic medical record (EMR) system they use looks like it was designed in the 1980s.
Gray boxes with tiny free text fields and little check boxes. Unfortunately, the aesthetics are the least infuriating design element.
Why is nothing connected in current EMRs? The single most important thing that has led to the proliferation and usability of information on the internet is linking. I can be reading a story in the New York Times and by simply clicking links within the story I’m taken to a dozen different sources giving me more in-depth information on unfamiliar topics.
In an EMR (I have used close to half a dozen of the most popular) nothing is connected. You have to have a mental picture of where information is located within the hidden folders of the EMR to find the information you need. How is that useful?
And the thing that truly baffles me –- why are hardware and software companies churning out things like Google Chrome, the iPhone, Wikipedia, YouTube, Android phones, the iPad, Gmail, Facebook, and Twitter but we still have EMR systems that look and act like Windows 95?
Never mind that no patient records are connected or even electronically exchangeable (at least not on any scale to make it useful). I can access my e-mail, bank accounts, travel information, even my research library, from any computer with an internet connection. But my patients still have to hand me paper copies of their records from other physicians, which they often forget or are illegible (and remember that it takes time, money, and paper to copy those records).
The patient I saw today — it would have been useful to know she had a prescription written last week by a physician at an urgent care clinic, then another one at the ER.
It also would have been useful to have notes, treatment plans, and medication orders from the endocrinologist and cardiologist who are treating my patient with poorly controlled diabetes. I might have been able to review these before I saw him, instead of wasting 14 minutes of our 15 minute visit trying to help him remember all his medications and instructions.
The state of medical records in our country is shameful. It’s not a particularly sexy problem or one that is going to be easily solved. Conflicting evidence exits regarding implementation of EMR systems and decreased morbidity and mortality.
However, the next generation of physicians have grown up in the digital age. They have learned to leverage technology to work more efficiently and effectively. Demand for well-designed EMRs will grow as these young physicians move onto the wards and further into administrative positions. Maybe that will be the catalyst for change.
I hope not, I don’t think I can wait that long.
Josh Herigon is a medical student who blogs a Number Needed to Treat.
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I have been interested in this problem for several years, and became much more focused when I moved my office recently and had over 200 boxes of paper records (from my predecessor) shredded (they dated to 1966.)
In his book “The Healing of America,” T.R. Reid describes health care systems in other countries. It is worth reading the description of the French universal EMR. This is encoded on everyone’s health insurance card. Progress notes are entered electronically and the system is also used for electronic billing. It seems to be used by all MD’s in the country.
I think this would never fly here because it is too centralized. Our free-market approach encourages small vendors to build proprietary systems that are DESIGNED not to communicate with each other. Price tags, maintenance and service contract costs are ridiculously high.
Open source EMR’s may be the answer but they are still clunky compared to other computer based systems.
Until there is a consensus that single payer healthcare is the only reasonable answer (eliminating the for-profit administrators that skin off 10-30% of each health care dollar, without adding anything to the provision of health care) we are doomed to this EMR hell.
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