Monday, December 15, 2014

EMR: Physician Rants

OK, I've heard some physician rants about Electronic Medical Records.  Change isn't always fun.  Here are some rants, just in case you or your physician are all giggles about the EMR, so you know there are other opinions.

"The Electronic Medical Record (EMR) is as "medical" as Medical Marijuana.  But, it helps to maximize "medical" billing.  It costs too much.  It leads to markedly diminished time for patient care.  It is shameful that it was mandated by poorly informed non-physicians.  It is shameful that physicians went along with it.  The idea seemed good, but the EMR doesn't deliver the goods to help patients or hospitals or physicians to improve quality and decrease cost. The new quality isn't quality- it's whatever is measurable.  We sold out our profession and our patients on this misguided transformation.  The Electronic Medical Record is an Electronic Billing Record."

Benefits:  Billing.  Medication lists.  Prescriptions. Legibility.

Harm: Loss of time.  Patient quality.  Patient satisfaction. Physician quality.  Physician autonomy.  Patient-Physician relationship.  Cost of health care.

What do you think?


  1. I agree with you completely.

    The problem isn't with the concept of electronic records themselves. Conceptually, computers are awesome and wonderful in so many ways it would be impossible to list them. They are just so much better than paper in regards to cost, storage space, reliability, ability to make multiple duplicates for off site storage, legibility, etc., etc., etc.

    All of the touted benefits of electronic medical records are absolutely true and being realized when electronic records are used in other fields. When used properly, they make things much more reliable, efficient, and cost effective.

    The problem with the medical field has to do with the bizarro-world bureacracy that exists, whereby everything has to fit within the insane confines of ICD-9 (soon to be ICD-10) and E&M codes, while simultaneously trying to navigate all the ridiculous proprietary requirements of various government and corporate third party payers, regulators, credentialers, etc. etc. etc.

    When having to reconcile all these disparate and non-sensicle parameters, you end up with bloated, ineffecient, massively overpriced, resource draining junk. Just pure junk.

    It kills me that the prevailing narrative from our "betters" in government and the news media is that doctors are just a bunch of luddites who are scared of change and don't want to embrace these newfangled computer contraptions. What a bunch of nonsense!

    In virtually every other area, doctors are pleased as punch to embrace the latest gizmos and technology. Everything from infrared thermometers and pulse oximeters to PET scanners, functional MRIs, and robotic surgeries. We love modern technology and the latest gizmos.

    We love them when they enhance our ability to care for patients, make us more productive, etc.

    Take away all the third party interference, and EMRs could easily be created that doctors would gleefully adopt. They could be made cheap, efficient and effective. Hell, probably everything we could ever want in a dream EMR could be done with a few tweaks to Microsoft Word. Unfortunately, it's not so easy to tweak Word to comply with all the outside nonesense that comes from our "We know better than all you stupid doctors" overlords in D.C., and corporate America.

    There is a reason entities like Medicare feel the need to take a carrot and stick approach to try to force doctors to adopt EMRs. You don't see anyone having to force doctors to use computers in virtually every other aspect of their lives. We gladly join the rest of society in logging in to check our email, surfing the web, engaging in social media, playing with smart phones, word processing, etc. We do this gleefully just like everyone else.

    Come up with an EMR that offers benefits that outweigh the costs and you won't need any carrots or sticks to get doctors on board. They will gladly add EMRs to their practice voluntarily. As long as all the third party bureacratic nonesense exists however, even an infinite number of monkeys coding for an infinite number of years will never come up with such an EMR. (They very likely will continue to get elected to public office however.)

    1. Thank you, Sam for your helpful reflections and insights. apj