EMR Doctor's Blog: Popular Misconceptions of Using an EHR System From a Provider’s Point of View
I thought it would be fun to discuss the “real world” of what it’s like to use an EHR system. Here are a few misconceptions that, if you believe all the advertising and other hype, you might have about the benefits of using an EHR system. Although the promise is definitely there in terms of what should be feasible ideally, the real world often determines otherwise.
Misconception 1. “I walk out of the office at 5 PM with all of my notes done for the day. Awesome!”
Maybe once every month I can do this, on a slow day. The fact is that all of the documentation that needs to be completed prior to signing a note usually cannot be done for all visit notes by the end of the day. There are a variety of issues. Patients throw you curve balls on the way out the door. Patients have complex issues that you need more time to research prior to finalizing your plans. Patients forget information that they want to call you back about later, e.g. missing medication names and doses, doctor’s names that they want you to cc:, etc. On busier days, when patients come in late and you end up juggling appointments to avoid refusing to see anyone (this is private practice with real cash flow needs after all!), or when the phone just ends up ringing off the hook with one urgent issue after another, signing all your notes by 5 PM becomes impossible.
Misconception 2. “It’s a breeze to electronically send all my prescriptions. I don’t need a scrip pad anymore! Woohoo!”
Mail order pharmacies destroyed this one with all their forms. Three-quarters of the patients in this category need me to fill out a paper form to fax in. The other 25% need paper scrips written out, typically five to ten at a time, so that they can mail them in themselves. Auto-renewal requests come in by fax every day, needing to be filled out and faxed back. My personal revenge comes in the form of being able to fill most of these out using my PDF editor software prior to faxing them back without touching a single microdot of ink to paper.
Misconception 3. “I don’t have to dictate anymore. Yippee!”
For all new patient visits, I end up dictating at least the history of present illness (i.e. “HPI”, the first paragraph or two telling the patient’s story for those of you unfamiliar with this terminology). Although I can eliminate paying for this service by using a free iPhone app (Dragon Dictation), I still have to go through the process of speaking and then editing the notes. The alternatives would involve me sitting there wasting huge amounts of time typing details into a paragraph or two for each patient, or I would end up doing what I see some of my referring docs do, which is to type in VERY brief notes that eliminate a lot of important details just to get by and move on to the next patient. Some contrarians might suggest that everything can be done through templates, which is partially true to some extent, but everyone’s story is unique and different, especially when you are dealing with subspeciality areas such as disorders of the thyroid and adrenal glands. The last time one of my patients had run-of-the-mill chest pain that could be reduced to a series of templated checkboxes to adequately describe their story was … well… never.
Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009. Check out all of Dr. West’s EMR Doctor’s Blog posts.
Thank you Dr. West. I’m an emergency doctor in a busy ED and would like to address a few more myths:
4. CPOE improves safety.
No it doesn’t. Two large well designed studies showed worse outcomes. In emergency medicine, CPOE reduces efficiency and distracts doctors involved in critical time senstive tasks.
5. (Name of Vender) has lowest click counts!
It doesn’t matter. You still have to find an open terminal, with a CPU with less RAM than a cell phone, hit 30 keystrokes to log in, and by that time you’ve already forgotten about the 6 other critical tasks, such as putting pacer pads on the unstable bradycardia. Whoops, now he’s in asystole because I was still logging in. It’s not about click counts–it’s about intrusion into our brain space.
6. Doctors just don’t like change.
Not true. We welcome improvements. Everyday in emergency medicine is different. We are constantly adjusting our staffing and workflow.
7. Doctors just don’t like technology.
Yeah right. We’re crazy about tech. We love gadgets that work. It’s the software that has utterly failed to even come close to accommodating our complex workflow and thought processes. If it worked we’d have been using it all along.
Many other myths, but this reply box is kind of small…
6. It’s best to have the data right at your fingertips.
Sure, and how doe
Brian,
You should use Chrome for your web browser. Then, you can expand the text box as large as you’d like;-)
Thanks for sharing the other myths. It seems like some of your perspective is specific to ED EMR and technology (which is fine and welcomed). For example, the doctors offices I work with don’t use a terminal that has less CPU and RAM than their cell phone. Although, in hospitals I think this is a common situation. Add in cool technology like the iPad and doctors have a lot of choices of how to interact with their EHR.
I agree that most doctors do love technology. If EMR software was just as compelling to use as Farmville, we wouldn’t have these issues.
Yeah I’m on an iPad so I can’t use Chrome. (Speaking of tech)
Hi Dr. West,
Thank you for the informative, but very entertaining (ie…funny! I laughed out loud) article. I plan on keeping it in mind going forward training my Docs.
Let me share this story with you as a patient, I had a doctors appointment in a new office the other day. They asked me to come in 15 minutes early to fill out paper work. I came in and as soon as i started filling it out i realized that I couldn’t remember anything about my previous medical history, such as the surgeries underwent and medications i was prescribed in the past to who my doctors were. I can see how beneficial it is to the consumer to own a PHR. Companies not only like Medefile Records would not only benefit people but also save time if ever in a emergency. Doctors would make far less mistakes anytime, or anywhere.
For more commentary on misperceptions related to EMRs, check out Nuesoft’s “EMR Mythbusters” podcast featuring HIT-savvy pediatricians Dr. Gregg Alexander and Dr. Andy Spooner. They share some of the views of Dr. West (and others who made comments), but also touch on a few more misnomers and sources of confusion related to EMR implementation.