Unlike EMRs, paper charts never crash

Unlike EMRs, paper charts never crash

Which of the following events is most traumatic for a practicing physician?

  • Your staff doesn’t show up because the roads are flooded, but the waiting room is full of patients.
  • Medicare notifies you that coding discrepancies will result in an audit of 2 years of Medicare records.
  • You receive an offer of employment by a corporate medical institution who will bury your practice if you do not sign.
  • Your key expert witness defending you in your upcoming medical malpractice case is incarcerated.
  • Your office electronic medical records (EMR) system suffers a cardiac arrest.

Tough choices, I know. Our office lost complete access to EMR for 3 days, and it wasn’t pretty. I don’t grasp the technical (doubletalk) explanation for the temporary EMR coma, but we were reminded of how dependent we are on technology. Our IT gurus were working tirelessly, but their adversary was wily and formidable. Finally, they prevailed, but I wouldn’t regard this as a clean win for us. We were hobbling for 3 days. The fried server has been rebuilt and now has reinforcements to insulate against another crippling assault.

Ink and paper never crash.

Luckily, our brains were still functioning adequately during these 72 hours. We hadn’t yet lost the ability to obtain a medical history without pointing & clicking. Somehow, we managed to obtain a review of systems without trolling and scrolling across our laptop monitors. Ancient physician techniques, such as maintaining eye contact and offering nods of understanding to patients, were effortlessly recalled, like riding a bicycle. I even prepared a few paper prescriptions, once I was able to locate a yellowed and tattered prescription pad. I hope the pharmacies will accept these medical anachronisms.

The tough reality is that during these 3 days we had no records available for the patients we saw. We compensated when we could, with faxes and phone reports, but this is no substitute for a complete medical record. Patients arrived to review test results that we couldn’t access. In some cases, I had faxed biopsy reports available, but not the accompanying endoscopy operative reports that were hiding in the EMR black hole. Patients were understanding of our dilemma, since many had faced their own computer rages. But, many of them did not receive a full measure of medical services from us. I asked some to return to see me for another visit, once the EMR was resuscitated, as I feared I may have overlooked some important issue during the 3 days of Stone Age medicine.

Technology is the opium of the people. We love technology. We demand it. We upgrade it. And, we are hooked on it. Like any addiction, when the fix isn’t there for us, withdrawal is painful.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

Image credit: Shutterstock.com

Comments are moderated before they are published. Please read the comment policy.

  • Coconutskinss

    Surely you are aware that paper charts have their own host of problems and are not full-proof either.

    A hard lesson to learn, but being prepared to take care of patients even if technology, medicines, transport fail are an important consideration.

  • southerndoc1

    I guess everyone’s seen this week’s report from the RAND corporation:
    “All those great benefits from EMRs we predicted back in 2005: never mind.”

  • RecordsDog

    Unfortunately, this will be the new normal. What will really blow your blood pressure through the ceiling is when the IT system crashes AND all the medical records go with it. Nothing like having the entire medical history of your patients go POOF!

  • LeoHolmMD

    CMS needs to add your EMR crashing to it’s “never events” or “don’t pay” list. Then it might stop.

  • MKirschMD

    EMR is solving problems I never had.

  • Larry Sheldon

    I don’t remember (as a patient) EVER seeing so many mysterious changes, corrections, additions and deletions that where made without any medical training in attendance.

  • Docbart

    Pen and paper don’t crash, and paper charts can’t be hacked remotely. Nothing is as fast as opening a paper chart and writing in it. Sadly, no one promotes paper charts because no one gets rich selling, maintaining and upgrading them. No one can easily extract data that can be used for purposes other than patient care so the bean counters can get paid for counting beans and telling doctors what they should be doing to maximize corporate profits. No wonder paper charts are as doomed as patient-centered private medical practice.

    • meyati

      But people can tear pages out. I’ve grabbed my chart a few times and did that.

      • Docbart

        Really? Wow. I have never heard of anyone doing that. I guess I haven’t gotten any of my patients as angry as you must be.

        • meyati

          I worked on ranches-did round up-branding-sometimes a new doctor from the city would say that i was delusional about that. One time, my regular doctor marched me down to the offending doctor’s office. I had a roping accident-and the staff at the air base called my reg. Anyway-I had blood, manure- spurs, horse hair-dirt-the works. My reg doc was a colonel- he pointed at me- and said- delusional? There is a difference between crazy and delusional.The poor kid took his page out and tore it it up. The Colonel said– This is west of the Pecos. So, I took out anything that said delusional-and took them to my regular doc. I loved the comment of where a doctor said that I attacked him with a wadded up mammogram order that was too precious to tear up.I went to a new colonel about that-who noted on the chart that a patient has a right to refuse mammograms and if I didn’t brandish a knife -it wasn’t an attack. . Seriously, I had a breast biopsy that gave me RSD. My right hand turned mostly black and the pain was worse than having my hand pulled off of a broken harm-I don’t mean fractured- I mean a dirty open break. The AF successfully treated the RSD. I was and still am terrified of anything that could set the RSD off. I have copies of those records. I can also read medical charts upside down-which has made some doctors uncomfortable with my questions. They put that down on the outside of my chart. I don’t know you- you don’t know me-but I don’t think that I’d like you- it depends on how intelligent and trainable you are.
          We got some coonhounds-my disabled vet told his medical team, support team, etc. He came home one day and told me they thought he was delusional. The next time I picked him up at the VA, he got the other patients, his social worker, a nurse out- because they wanted to confront him with the truth and talk to me. OK- when we pulled up with a pair of 100 lb long eared Coonhounds that were baying and wagging their tails you should have seen their faces-priceless. The staff was so delighted with the hounds that they took pictures, and some even asked me what were good hounds, and they bought some for their selves. So be careful on psychoanalyzing people from a word or two.

          • Docbart

            Sure. Right.

        • EmilyAnon

          When I accessed my medical chart (paper) I could only view them with a hospital person present. The purpose obviously was to thwart altering or removal of any records.

          I don’t think it takes an angry patient to attempt this, but rather a desperate patient who might fear the information will instigate denial of future insurance coverage.

          • Docbart

            Denial of insurance is certainly a concern, but should get better under Obamacare.

            Deleting relevant history from charts is really destructive, though, and can cause very serious problems with caring for the patient, as well as medico-legal nightmares.

  • http://twitter.com/FerkhamPasha Ferkham pasha

    That’s so true paper charts don’t give downtime!

  • ButIPlayOneOnTV

    Dr. Kirsch, do you expect EMRs to allow you to further ignore your patients?

  • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

    While there certainly does need to be discussion about the downsides of EMR, the same arguments here could have been written decades ago when we started using computers. Yes, computers crash. Yes, EMR could crash. But should we not use them because of that? We should focus on the downsides of paper and pens, too: they are time-consuming, inefficient, and disorganized.

    • http://www.facebook.com/obinna.akunna Obinna Akunna

      They were inefficient and disorganized but hiring one or two extra people in your office could go along way. With EHR and all the required support needed, it is a bottomless money pit.

      • Ginger

        From the perspective of a patient, who isn’t there for 3 full days of non-functional systems, paper charts had issues. Records were lost, files couldn’t be found, results were misplaced. Now if I ask, “how does this result compare to before when I…” my Doc can pull the result from then up. With a paper chart I’d hear things like, “well we took everything more than 3 years old out and archived them…” If I show up with an urgent concern after not being seen for 3 years I don’t hear, “your records got sent to storage we can’t get it.”
        I will say that sometimes I think my relationship is more with my health systems record system than with any one provider, but overall I like that whoever I see can find out almost anything about me with just a few clicks.

        • meyati

          They don’t have to spend a half hour thumbing through a paper chart for lab work, and asking you if you really did go to the lab. I can send a message through the EMR to my doctor-he can review my chart-see my meds and medical history-and order lab work- write a script or explain something to me. I can look up lab work, see pending tests-and know when to get my rear into the lab. There’s communication between the ER, UC clinics and my doctor.

  • SarahJ88

    I’ve stopped talking to my medical providers since the advent of electronic records. I have lost any sense of privacy, I know any errors will be unfixable and my doctors no longer look at me during appointments–they’re too busy satisfying the needs of the laptop gods.

  • ninguem

    A big multisite, multispecialty clinic in my area, over 60 years old, about 800,000 patients in two states.

    A couple times I’ve called them about a patient of theirs, to find out the entire EHR system was down. The whole thing, all over the area.

    They couldn’t tell me a single thing about the patient of their system, who happened to be in my office for some reason or other.


    • meyati

      You get the same result when the paper chart is lost

  • querywoman

    Once I took a public bus to a dentist’s office in the Texas afternoon heat. Since becoming an insulin dependent diabetic, I am very temperature system.
    I was heat-sick.
    The dentist’s office could not see me because the computerized Xray machine was down. I refused to reschedule.

    Next time I called another dentist, I asked if they had a noncomputerized Xray machine for backup.

    The real truth is you always need a backup system. Ideally, med records should be on paper and in a computer

  • http://www.facebook.com/SamBruinewoud Sam Bruinewoud

    Can anyone say ‘echo chamber’?

  • http://www.facebook.com/shirie.leng Shirie Leng

    In this day of cloud computing, EMRs really shouldn’t crash. This should be a requirement for approval of EMR systems. Until such time as that is possible, perhaps we should have duplicate systems, computer and paper, i.e., printing out everything we type. Wasteful, but if it’s important it needs to be backed up by a more reliable system. I hate EMR as much as the next guy but it’s here, so I choose to back up my electronics with paper. That way I can talk to the patient and not the computer.

  • meyati

    Ever get your paper chart misplaced in a large hospital or accidently thrown out?. Ever find other patients’ lab work in your own? Ever have a doctor hand you your chart, and say, “Do you have any idea what this doctor is saying”?

Most Popular