At the start of the transition to electronic health records (EHRs), I was totally on board as one would expect of a millennial doctor. I, along with my fellow millennials, grew up alongside the internet. We can type with our eyes closed, navigate pop-ups in a jiffy and intuitively know how to manipulate electronic charts to serve our purposes.
But, I did find myself in a unique position in the millennial doctor cohort — I am an ancient millennial, if you will. Early on in my career, I remember documenting in five-pound paper charts and trying to decipher the illegible scribbles of specialists, too afraid to call them for clarification.
As one of the first young doctors to face the transition between paper charts and EHRs, I fully embraced their benefits with open arms. Instead of handwriting labs on a carbon piece of paper and hoping the right labs would get drawn somehow, I could electronically order the labs I wanted and know they were input correctly. I could actually read progress notes and consultations!
In contrast, many in the older generation of doctors abhorred the transition to EHRs. They preferred dictation to typing, would become furious with the never-ending alerts and had no interest in setting up templates for their own use. They prophesied doomsday predictions about how this was the end of medicine as we knew it.
I would scoff at their resistance to learning how to navigate these systems — this was clearly the wave of the future! However, after watching the use of the electronic medical record transform over time, I am coming to realize I cast aside their concerns too quickly.
For all of EHR’s benefits, over an eight-year spread from the time I was a third-year medical student to now in my third year of private practice, I’ve seen electronic medical records devolve from its initial use as an aid to maximize efficiency. Instead, it has turned into a hodgepodge of patient data, stripped from any real information and of utmost concern, stripped from its humanity. Moreover, EHRss no longer aid in efficiency — for every one hour spent in patient care, two hours of EHR tasks are generated.
Just recently, I saw a patient in clinic for an ER visit follow-up. Reviewing his ER note before I walked into the exam room, I tried to make sense of the 10-page document and could only find these items of value:
Duration: 4 hours
Location: left lateral ribs
Provocating factors: movement, twisting, palpation
Palliating factors: rest
Meds: ibuprofen prior to arrival
Assessment/plan: Left lateral rib fracture #7-9, follow up with PCP
When I walked into the room, I apologized to the patient. “I read your ER note, but I’m sorry — I’m not quite sure what happened?” Apparently, the patient had fallen down his stairs, caught his hand in the banister and somehow crashed on his ribs. None of that had been relayed in the note.
Instead, what happened was a provider became too click-happy following the set template in an effort to provide enough data to meet insurance criteria for reimbursement, rather than focusing on providing real information on the events that transpired. With a more discerning eye, I started reading notes I was getting from other facilities, the patient’s old records from other primary care providers and ER records — all with the same trend. All data with no actual information.
What has happened to our physician notes?
Is this what we’ve been reduced to? Clicking the right keywords in pre-formulated text fields so we can meet the minimum criteria to get paid? Has the profession of medicine turned into churning out glorified EHR technicians?
The original intent of a physician note was so we could relay what happened if we have to remind ourselves of events in the future. Now, we get attachments of reams and reams of meaningless vital signs and patient education handouts to filter through in order to get to the high yield information, if there even is any.
Looking toward the future, what is going to stop physicians and other healthcare providers from being replaced by artificial intelligence like IBM’s Watson? A patient can easily type in/tell Watson what their symptoms are themselves, Watson can prompt additional follow up questions and eventually come up with a diagnosis without our input — are EHRs just facilitating the demise of medicine as we know it, as my predecessors prophesied?
I’d like to believe that patients still want that human experience when coming to their health care providers for care. And I fully realize just because the notes are not ideal does not mean patients did not receive ideal and appropriate medical care.
But I propose we are devaluing our expertise by reducing our thinking to preset text fields. We are catering to the whims of insurance companies by creating a note that checks off those checkboxes for reimbursement purposes. We are inviting automation of medicine through EHRs through our point-and-click love affair.
We need to take back control of this very important and useful tool.
So the next time you sit down to write that note, think to yourself, “Am I just documenting data, or am I relaying actual information?”
“Millennial Doctor” is an internal medicine-pediatrics physician who blogs at Reflections of a Millennial Doctor.
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