How have EMRs changed the doctor-patient relationship?

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.  Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.  Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.  But, keep in mind that these systems were not devised and implemented because physicians demanded them.  To the contrary, they were designed to simplify and automate billing and coding.  While this made their tasks considerably easier, it was at physicians’ expense.  Features that helped billers and insurance companies didn’t help us take care of living and breathing human beings.   It made us focus on silly documentation requirements in order to be fairly reimbursed.  And, it offered very clumsy mechanisms to record a patient’s history — the story of your symptoms — which is our most valuable piece of medical data.  You simply can’t click your way through a patient’s narrative.

Admittedly, the process is much better now than it was a decade ago.  But, it cannot replicate the experience of pen & paper when physicians could use eye contact, facial expression, and nodding of the head during office visits.  Indeed, this is how I practiced for the majority of my career.

A recent job change has given me the pleasure of learning a brand new EMR system.   Learning a new system has been like a undergoing colonoscopy: uncomfortable but necessary.  I wonder how many hundreds of clicks I perform each week as I navigate through a system that seems to have no boundaries.  While some of my colleagues use voice to text technology, or have a scribe shadowing them, I rely upon my ten digits tapping across the keyboard to get the job done.  And, since I worked as a typist before becoming a gastroenterologist, I can look my patients in the eye while typing.  (Interesting that a typist and a gastroenterologist both need to be digitally skilled.  Perhaps, in my retirement I will study piano?)

I wonder how the EMR arena has been for patients.  Please share your experiences here especially if you are old (ancient) enough to be able to compare current click medicine to pen and paper documentation.  How has your office visits changed?  Do you think EMR has changed the doctor-patient relationship?  Share your frustrations.  Let me prompt you with frustration #1: Why don’t all the EMR systems communicate with each other?  Why is this promise still unfulfilled?

Using the ubiquitous rating system, how many stars would you award the EMR experience?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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