Why Aren't Our Medical Records Digital?

7 years ago

Nurse Examining Clipboard

Some workflow processes are so ingrained in our psyches, that they've become iconic images of a job. Think of someone at the dry cleaners, and you see an image of someone sticking a safety pin into your clothes to tag it. Think of a waitress and you have a vision of someone writing down your order on a small pad. Think of a doctor entering the examination room you've been waiting in for 15-20 minutes (on a good day) and you see your doctor holding a clipboard with your patient file.

Doctors are under pressure to give up their clipboards and start using Electronic Medical Records (EMR). Pressure might be too weak of a word for the situation. While technically it is not a mandate -- just ask a community of medical transcriptionists and they'll tell you it's a hoax -- starting in 2014, there will be financial penalties for non-EMR physicians who see Medicaid or Medicare patients. So there's real pressure to use EMR.

However, a recent survey by the Centers for Disease Control and Prevention found that only six percent of all physicians use full-blown EMR systems while 20 percent have some basic EMR system in their office. That's after 20 years of EMRs being on the market. Proponents say EMRs improve health care for patients, save physicians time and money.

So what gives? Why are physicians so reluctant to give up those clipboards and paper patient files?

It's a combination of factors: cost, the short-term loss in productivity required to learn how to use the system, but most importantly (as my brother, who blogs at Medrants pointed out in 2007 explained), most EMR systems were initially created to help streamline the billing process, not to provide better patient care. In the three years since he wrote that post, a lot has changed.

There are now more than 300 different vendors selling some form of electronic medical records systems. The surge in vendors is in direct proportion to the $17 billion in incentives physicians are eligible to receive for going digital, thanks to the 2009 stimulus package.

Still, even with those incentives, experts say doctors will continue to drag their feet. According to that Centers for Disease Control and Prevention survey:

Many experts have said that even with the incentives, the cost of a system -- and the loss of revenue a practice can expect when installing and adjusting to it -- still have many physicians believing an EMR is an expensive investment with little return.

Writing about the less than enthusiastic response physicians have had towards EMR systems, Mary Pat Whaley, an expert in healthcare management, says there are 10 solid reasons why doctors aren't racing to install these systems.

  • Physicians are worried about the drop in production that (some say) happens when a practice launches an EMR.
  • There seems to be as many horror stories as there are success stories with EMRs.
  • Practices that are affiliated with a hospital are nervous about tying themselves to the hospital in such a serious way as hopping on their EMR package
  • Because two practices can have absolutely opposite experiences with the same EMR, no one can find consistent recommendations for any single product. (It’s not the product, it’s the implementation!)

In a serendipitous moment, I had my first EMR experience as a patient last Thursday during a visit to the University of Minnesota eye clinic. Seeing it as an opportunity to get some primary research about the effectiveness of these systems, I started bombarding my physician with questions about the EMR.

He didn't refuse to answer my questions, but clearly he wasn't eager to participate in my impromptu interview. He did have a schedule to maintain, and he wanted to spend the time talking about my contact lens and my astigmatism, not the hospital's EMR system.

Nevertheless, he did share that they had been using the EMR system for nearly two years (yes, that's how long it's been since I had my last eye exam), and my impression from his shoulder shrug was that it wasn't making his life better or easier. Again, that conclusion is body-language based. He didn't say a bad word about the system. He did add that after just two years of use, the hospital was getting ready to install a completely different system. Another shoulder shrug.

While Mary Pat Whaley listed 10 reasons for why doctors were not jumping on the EMR bandwagon, I think there is another more fundamental reason. Doctors don't want to give up their clipboard and paper files because using a computer changes the dynamics of how they interact with their patients. As Pauline Chen described in her blog post, An Unforeseen Complication of Electronic Medical Records, the first time she used the EMR with a patient was extremely awkward.

I realized I had no idea where to sit. The new computer was perched atop a desk in one corner of the room; the patient sat on the exam table on the other side of the room. In order to use the computer, I had to turn my back to the patient as I spoke to him. I tried to compensate by sitting on a rolling stool but soon found myself spending more time spinning and wheeling back and forth between patient and computer than I did sitting still and listening. And when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent.

Much of the conversation about EMRs focuses on the business aspect. Will it save money? Will it make the office more productive? What's missing from this conversation is patient care: Does having an EMR system improve it? Some say that's a debatable question. More on that later.

BlogHer Contributing Editor: Business & Career

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