The Implications of Electronic Medical Record Systems (Or How I Learned to Stop Living and Love the Mouse)

Over the past 10 years, especially since 2009, thousands of medical offices throughout the United States converted from traditional paper medical records to electronic based systems.  The United States Government offered bonuses to help incentivize the purchase of electronic medical records (EMRs) in 2009 under the HITECH act.
Today's blog post isn't to discuss the economic costs versus benefits of the EMR.  There are plenty of articles online regarding that (like this one here).  I am writing today to discuss the real life IMPLICATIONS of the consequences of encouraging the implementation of EMRs.

First, lets discuss the benefits of having an EMR in my office:

• I can have secure digital access to your health information from nearly anywhere on the planet with an internet connection.
• Most prescriptions can be automatically sent to the pharmacy securely.  This way, there are no lost prescriptions.  It cuts down on fraudulent prescriptions
• Alerts and reminders can populate the system to remind me of needed preventative care services (such as ordering mammograms, colonoscopy, immunizations, etc).
• I can run a query to find the patients who have uncontrolled diabetes and haven't had their labs checked in the past 3 months, in order to call them in for an appointment.
• Graphs can be created to show trends in data (such as height, weight, kidney function, etc).

Now, the negatives aspects of the EMR:

• Every observation and lab is a data point.  I need to click a million buttons in order to label each measurable bit of information for the EMR to be able to perform the queries mentioned above.  I used to be able to look a patient in the eye when obtaining a medical history.  Nowadays I am too busy staring at the laptop screen.
• The software is buggy, and non-responsive.  At times it will take up to 15 seconds to load the next page.  This is a time lost forever.
• So much time is spent documenting on the patient note, that I am seeing 10 less patients a day than 8 years ago prior to transitioning to electronic medical records.
• I now have 1-3 hours of additional work to address at night from home after leaving the office.

Seven years ago I was averaging seeing 25+ patients a day in the office; I would leave the office no later than 6 PM, and be free all night long.  Today, I average seeing around 15 patients a day; I leave the office around 6:30 PM, and I have an additional 2 hours of work each night.  Doctors are spending way more time documenting encounters on way fewer patients.  This is bad for society in terms of population health:  doctors aren't able to see the patients that need to be seen, because of the administrative burden put on them.   And with the generation of baby boomers retiring, there is a major shortage of doctors developing.  That's why so-called mid-level practitioners are proliferating.  And these providers play an important role.  But they do not have the same education, training, or experience as a physician.

So what is the solution?
I love technology.  The potential is there.  Unfortunately, every electronic medical record system I have seen has been designed by people who have no clue what it is like to practice in the real world. (As an aside, we had some software engineers and vice-presidents of the software company for our EMR come out to get an idea of how we use it.  They followed one of the docs around, and saw his frustration and the software's lag.  They commented how they never saw anybody use the program so quickly.  Welcome to the real world, Mr VP.  Your product sucks!  And we're paying for it in more ways than one.) The software layouts aren't intuitive.  Information that would be helpful is located two screens away, unable to be viewed simultaneously.  The software is clunky, pauses, or shuts down.
There needs to be a Steve Jobs of EMR design and function.  There is none currently.  Every system stinks.  If an iPhone can be so intuitive and simple, why can't the templates for a patient encounter be as easy?
There needs to be an industry standard that would allow easy communication of data between companies.  Banking has standards.  Why can't EMRs have interchangeability?  That way, if you don't like your current vendor, you could just transfer all of your last 10 years of work into the new system.  But so many of us are so invested that the thought of re-entering years of history (data) into a new system is overwhelming (we're in too deep).
The only current standards are dictated by the government.  And it is my suspicion that due to each new regulation they roll out, the back end of the software gets more complex due to patches and changes, causing a slower and more difficult user experience on the front end by the provider.

I predict that the user experience in EMRs will be significantly improved and somewhat intuitive in 10 to 15 years.  I suspect for some systems tangible changes will be felt in 5 years.  With advances in AI, EMRs will really provide a simple experience for the doctor.  Unfortunately, by the time that happens, the AI will be treating patients, and it'll be retirement time for me.