A few months back I wrote an article about Electronic Medical Records or the new EMR system. Techies beware — you may not like what you are about to read. I want to relay to you my recent experiences in the past week.
On Monday, I accompanied a client to see his primary care physician for a yearly exam. His physician entered the room, sat his computer on a table and started typing. The physician followed the prompted questions on the screen. When a question brought up another issue that my client or I wanted to address, he replied, "Not yet, I'm not there yet." The message was clear: It was stop and start, don't ask any questions and certainly do not interject. Sadly, the computer simply won't allow for such personalization.
Walking out of that appointment was emotionally draining. There was a limited opportunity for discussion to offer pertinent information because the computer program won't allow for a flowing conversation or a chance to actually provide a comprehensive history. We're just not on that page.
Ahh, Electronic Medical Records — the answer to our health care problems. The solution that will improve quality of care, safety, efficiency, and reduce health disparities. The EMR/ EHR system that is believed by the Federal government to engage patients and families and improve care coordination.
Maybe the Federal government thinks that the computer programs are the be-all, end-all to health care, but what about that comprehensive patient history? What about making eye contact while asking those questions? There's a lot of valuable information in those opportunities to observe body language, cues and to just listen.
And then there's the physical exam. How much time is left to actually examine the patient after the volumes of questions? With patients booked on top of one another, the exam time is limited due to navigating the computer program. Clearly programmers did not follow physicians through a typical day. Most offices that I visit are on their second or third EMR system since the mandate to utilize EMR. Who is paying for these systems? Certainly offices are absorbing the costs of EMR.
On Thursday, I accompanied another client to a Primary Care appointment. It was a new client to the physician. He spoke with my client, he asked him questions, he faced him and angled his body toward him, patted her shoulder at one point, and then he said, "I'm going to call your other physician and discuss this problem with her." In that very moment it hit me: Where's the computer? And you are going to walk out of this very office appointment to call another physician to talk on the real live telephone? Now?
After nearly falling off my chair, I asked, "Where is the computer?" To my surprise, he responded "I don't use one." He spoke to my client, engaged him, took a thorough history (in which he looked to his caregiver and myself to add comments), and actually wrote notes on a blank piece of paper. He got more information in that time than the first physician as he hunted and pecked his way through some programmer's idea of what it is that a clinician needs in order to take care of a patient.
In addition, he spoke with the other physician and came back with an answer and a plan to solve the problem (all in under the amount of time doctor No. 1 took). So much for the government's idea of efficiency, safety and quality of care.
While there are benefits (that even I will admit to) such as the ability to look at your medical records and the print-out at the end of the visit (which you may or may not understand depending on the program being used), I have to ask, is it really worth the sacrifice? No one seems to have time to look at each other's records or talk to each other with all this hunting and pecking going on behind the screen.
So what's the catch? Why isn't everyone opting out of the idea of EMR? Why aren't more doctors giving up after the second or third system and returning to pen and paper? The answer: The penalty for not participating in EMR is 1 percent of the Medicare/ Medicaid reimbursement in the first year with additional penalties annually thereafter.
I asked doctor No. 2 "what about the penalties?" He's decided to take the financial hit to be able to continue to practice medicine the good old fashioned way … with a pen and paper.