A long time ago in a galaxy far, far away … what an uncannily accurate description of how it feels to practice in our very own “modern” health care system. In a world brimming over with exponential tech advances — supercomputer smartphones with user interfaces an embryo could master, an open Internet backbone that connects us across continents and cultures — our health care universe languishes with software that’s the clinical equivalent of a Death Star. Overwrought, highly complex, and insanely expensive, yet ultimately foiled by the simplest weakness: a complete neglect of the Force, that mystical energy field between caregiver and patient. The Empire may have mandated electronic health records (EHRs) to bring order to the galaxy, but the Force has lost its balance — and the Jedi have had enough.
How do we know? Just ask them. As a practicing physician for over a decade, I bore witness to the transition from the Old Republic of paper charts, crappy handwriting, and preventable errors to the new Galactic Empire of EHRs, which brought us crappy cut-and-paste notes and more preventable errors. I saw both the promise and the peril of the new technological terror they’d created. And I witnessed the Jedi — front line practitioners of the medical arts — burning out in droves. In fact, I was one of them. Like 60 percent of physicians, I wouldn’t have recommended the career to my own children. Like 43 percent of doctors polled by the American Medical Association, I believe that the EHR had has made my job much more difficult.
Given that physicians often feel they have no voice, I resorted to a slightly unorthodox mouthpiece: a YouTube parody rap video called EHR State of Mind. Creating it was beyond cathartic (especially smashing all those computers), but the overall message is that EHRs (and all technology, in fact) must above all let doctors be doctors. The video had a huge response, with thousands of caregivers speaking out across social media via the #LetDoctorsBeDoctors hashtag. The comments illustrated the vast scope of Jedi despair, starting with the destruction of the patient relationship in favor of a relationship with crappy software:
“Sad to spend my day staring at a screen while people share vulnerable moments.”
“I spend more time clicking boxes than assessing and caring for my patients.”
“We have lost that intimate relationship with our patients & the art of medicine … Instead, we are turned into robots.”
We’re more machine than man now … Doc Vader, anyone? Other comments highlighted the terrible interfaces and inefficiencies that come with current EHRs, most of which are really just glorified billing platforms with some patient care tacked on:
“The EMR is built for the billers and not for health care providers. Doctors and patients should be the focus of EMR design, not reimbursements.”
“Technology should make the message more clear, legible and transferable. Patients look at their own chart and do not recognize themselves.”
“EHRs were designed to decrease errors. I don’t believe I am making fewer errors. I am simply making different errors.”
Depressed and angry yet? We’re not done. Billions spent due to government mandates and your EHR2-D2 unit still can’t talk to the BB-8 droid across the street WITHOUT A FAX MACHINE:
“We have two hospital systems in the Rochester NY area. Both use (the same EHR), but different versions and they do not communicate. What?!!”
“I can’t sleep at night because I know we’re going to kill someone as our inpatient prescribing systems are not interoperable.”
Expensive, unusable, unconnected software that abuses doctors and fails patients — the Dark Side, this is. But there has been an awakening in the Force … have you sensed it? The Jedi are finding their voice again, and are beginning to make it heard:
“The EMR that works best is the one that is fluid. It doesn’t have 87,000 tabs. It has what the setting requires and is easily adapted when change comes about. Make that and you’ll change the world.”
“EHRs can be a good thing for patient care if WE make it that way. Doctors need to make this happen, not policy makers. Empower physicians to build our own platforms … to take care of our patients within the EHR. Make the EHR as user-friendly as my wife’s Pinterest app or Facebook. Look to the current software industry AND physicians TOGETHER to make the EHR work for all.”
“Help us help patients.”
At the climax of the original Star Wars film, Luke Skywalker turns off his flight computer and pushes the screen out of the way. He is desperate to connect with the Force, to reconnect with the present moment. Why should it be any different in medicine? Technology should enable and enhance the human connection, and then get out of the way. The opposite has happened with current EHRs, and that has to change. No one wants to return to the dark ages of paper charts, so physicians and health care providers everywhere need to demand better usability from our EHR vendors, and more intelligent oversight from government. We need to demand technology that lets doctors be doctors.
Image credit: YouTube