Patient safety suffers when doctors are forced to learn multiple EMRs

As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.

What has happened in the past two days? As I will be working at two separate hospitals, for the past two days I have sat through training for at least 5 different EMR systems, none of which are similar or produced by the same company, all of which are designed to do the exact same things as hundreds of other EMR systems used in other parts of the country.

What really drove this home, as I zoned out during training for the 4th EMR system of the day, was the fact that in the mix, I didn’t receive access for one of the EMR systems. The technician at the training center instructed me to call help desk when I got home. At home on the phone with the help desk specialist, I was told that the issue unfortunately could not be solved on the phone and I would have to return to the training center. As I hung up the phone, I thought how nice it would have been if I had found this out 15 minutes ago when I was still at the training center.

But I wasn’t told that stopping by the help desk was an option. I wasn’t informed that the help desk was in the same building as the training center. I didn’t know that there was a possibility that this issue could not be solved on the phone.

Could this whole ordeal have been foreseen? Could it even be possible that I’m not the first person who fell through this trap? Very likely. But this is only one of the possible failings in our highly fragmented, variable medical system. With 5 different EMR systems in only two hospitals, how could a human being possibly plan for all the possible shortcomings these non-uniform processes create?

It’s not a matter of inconvenience that new providers have to learn 5 new computer systems in two days – it is a matter of patient safety. I continue to be amazed that despite all our advances, we as a country have not reconciled our differences and agreed on a uniform EMR across most, if not all, medical institutions. The benefits are many, including the ability to consolidate fragmented/repetitive medical information, better coordinate care and reduce possible mishaps created by each separate system. The waste that goes into reinventing the wheel, retraining medical professionals, troubleshooting hundreds of different EMR systems nationwide is likely enormous.

I believe that amidst the effort to reform health care, the time is ripe for us as a country to put our self-interests aside and work together so that future medical professionals and patients do not have to settle for this substandard, fragmented medical system. But until then, I am walking back to the training center to tell Jim, my computer trainer, what had happened to me so that future interns can have an extra hour in the sun instead of spending time at a computer training center.

angienadia is an internal medicine physician who blogs at Primary Dx.

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  • jsmith

    Good to see a young doc seeing through the EHR lunacy. Maybe there’s some hope for the future of the profession!

  • Roger Shindell

    I couldn’t agree with you more. What we need is system similar to the Fed’s check clearing system, which has been functioning since 1913. It is the reason my Quicken can aggregate information from all my accounts into one user interface, and allow we to transmit any specified information to any institution, as I see fit. the Nationwide Health Information Network and NHIN Direct programs in the HITECH Act are moving in the right direction. Hopefully we will get there in short order. For more information, check out:

  • joe

    You do understand why this has happened correct? The vendors have given millions to lobbyists/congress. Add to that misguided civil libertarians and legal entities (ACLU) which have argued long and hard about the theoretical risks of EMR and patient pivacy. The result is dozens and dozens of systems that operate via different means and don’t talk to one another at the costs of billions of dollars. Wait until the next step when the software vendors start spending billions so these systems can communicate with one another. This would be laughable if we were not paying for it and patient care was suffering.

  • John

    I’m not sure I’d blame this on the EMR vendors out there. Sure, they can bear some part of the blame. However, what you describe sounds like the fault of the IT people at the hospital that chose to implement it in such a shoddy way. How unfortunate!

  • joe

    No you are missing the point.
    Any attempts at picking one national EMR have been squleched before they started. This partly comes down to vendor lobbyist’s affect on congress. Having dozens and dozens of EMR’s that don’t talk with one another and cannot be accessed fractures patient care and in the end harms patients. I don’t expect you to understand, from your website you have a vested interest in the status quo. The VA computer system (and I don’t usually sing praises of the VA) is what should be modeled. Frankly I have found few private EMR’s that are in the same league as the VA system, and I have used many. Sadly I have had to relearn many different systems often at the expense of the patient. But setting up a national EMR will never happen, too many people have been paid off politically. So we will end up with these assinine initiatives where the government will help paying for various systems and in the end after billions of dollars we continue to have dozens and dozens of systems that don’t talk with one another. Next the IT people can make more billions making these systems try to communicate with one another. This is akin to NATO having each member nation with different guns and different ammunition then thereafter try to fix the problem. NATO figured out the idiocy of that strategy 40 years ago and that standardization is the way to go. It is something that would have also happened in this situation if politicans had not been paid off or rather had “campaign donations” made to their reelection coffers. It never ceases to amaze me how little input the politicains and software vendors ask of the people using the product, the doctors, nurses, and other healthcare personnel.

  • Marc Gorayeb, MD

    The strategy is working. Make it complicated and unworkable, then people will complain that it isn’t all uniform and provided by the same vendor, (maybe by the government!) If only we had just one choice.
    Never mind that the paper-based system worked much better than this; we’re past that now. Now it’s an electronic mess, and only the government can parachute in and ‘fix’ it. One e-system. While we’re at it, why don’t we just make it one payor? Oh, what the hell, let’s just have universal government health care!

    So let me get this straight. You innovate and meet the needs of consumers by NOT having many vendors competing on price, services and features?

  • Roger Shindell

    The issue is not that there multiple EHR systems nor that they can’t talk to each other directly. The challenge which is being addressed is for each system to talk to a common third party. This allows the market to choose the best EHR for a particular use yet allow all the stake holders access to all of a patients information. We’re not there yet but the industry, as has every other industry, will migrate to that model. I do believe though that the government could do more to move the industry along. Instead of CMS requiring every system to communicate with them, they should require every system to communicate to a third party public/private HIN. And if the VA did the same, EVERYONE would quickly follow by necessity

  • joe

    Two points
    @ Marc Gorayeb: Just how well has a decade of “vendor competition” worked for you? From my vantage it is a disaster. No system has yet come close to that big bad VA in which in the past I have accessed patient records from all over the country. Sorry but you are drinking the software vendor koolaid.

    @ Roger Shindell: I was accessing VA records nationally a decade ago in residency. The “incompetant” VA is way ahead of the game. And think about it, trying to figure out all these different software programs communicating to a “third party” (that is if the misguided “civil rights” advocates lose their suits). What a financial bonanza to the EMR vendor industry. Honestly, the lobbyist dollars are gong to pay off big time.
    This is a national issue and should have a national solution. We don’t have 50 state militia’s making up the US Army and there is a reason for that. Because standardization works (except for those making money off the status quo).

  • Bob Coli, MD

    Dr. Nadia and Gentlemen,

    I share the frustrations of Dr. Nadia. Why don’t all EHR and HIE platforms (including the VistA and AHLTA EHRs) already use a standard format for reporting patient diagnostic test results that is clinically logical and physician, platform and vendor-neutral?

    I believe the lack of a standard format for more efficiently viewing and sharing cumulative test results is another indication of the persistence of the longstanding sellers’ market that exists for the vendors of hundreds of ambulatory EMRs and dozens of hospital EMR and HIE platforms. Because they are still insulated from having to meet the workflow needs, pricing and quality concerns of end users, they have continued to ignore the chronic unmet need to more efficiently manage the growing volumes of test results.

    One of the biggest usability failures of all existing EMR and HIE platform products is their perpetuation of flawed, infinitely variable formats that display the results of billions of annual diagnostic tests as fragmented, incomplete data that disrupts the workflow of physicians and nurses.

    The logical solution is using a standard format to report all 6,500 different cumulative test results as clinically integrated, complete information that is easily viewed and shared on up to 80 percent fewer screens.

    Despite the need, as long as the status quo prevails, there will be no compelling product differentiation incentives to harness reporting format standardization and data integration in order to dramatically improve the viewing and sharing of this vital clinical patient information.

    Comprehensive market-oriented public policy reforms would transform the existing sellers’ market for HIT products into a consumer-centered, buyers market. Commercial HIT vendor success would then depend on continuously improving the usability and overall value of products to compete for the business of each new generation of clinicians and nurses. I believe achieving this would significantly increase the chances of successfully introducing a standard test results reporting format or any other truly disruptive HIT innovation in the United States.

  • gzuckier

    Note that somehow, America always ends up incorporating the inferior technology as the standard when there is a choice; VHS videotapes, 44 kHz CDs, 18kHz subcarrier FM stereo, IBM PCs, NTSC video, Windows, etc. etc. etc.

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