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January 5, 2015
I have always prided myself for not complaining about the problems of my life whether physical or mental. I am going to break that code now out of a desire to tell a story to anyone who has recently visited a physician's office.
When I was at Emory medical school in 1994, we were starting to use computers for our patient charting. As a student dedicated to one patient, it would take me an hour to type in one patient encounter. As a medical student this time was expendable although still unproductive. When I moved to the University of Virginia for pediatric residency training I was grateful to be back in the paper patient charting world. My early years at Salisbury Pediatric Associates was more of the beautiful paper chart. The patient was the focus of the visit. Life was good.
Years passed and medical computing companies began shopping their electronic medical records products to us. They touted cost savings, legible and transferable documents and improved efficiencies of patient care. We waited because of costs and fear. We wanted to see how other group's responded to the touted benefits. During the late 2000's great pressures were brought upon the medical community to make medicine all electronic. The Federal government and hospital systems were pushing this agenda despite physician fear and resistance. Unfortunately, this has turned into a first class debacle. The fear of not being paid appropriately if groups did not switch to EMR and the offer of government funding to help defray the expensive startup costs started the dominos falling toward EMR. What happened?
What we got for our money was hundreds of different systems in the country that do not talk to each other, make the practice of medicine less efficient, reduce the quality of the note for review, increase the overhead costs and generally add little value to the patient or provider. One of the smartest physicians that I know retired early instead of having to deal with the new world of cumbersome medical electronic records. That was tragic for the community where he practices.
There is no debate that we need an electronic health record that serves the patient and the provider. Unfortunately, we have neither in the current system.
For point of reference, imagine using a 1990's PC with its programs to do business in today's market and that is how we physicians feel today. Every other industry in the world benefits from computing for quality and efficiency, we have the opposite effect. The systems are slow, cumbersome and dramatically reduce efficiency. I once told someone that I wish Steve Jobs were alive to take this mess over and deliver a system that benefits the patient and the provider, the only two people that should matter. What we need is one system that traverses the entire medical community and is not used until it has proven to enhance medical care and be efficient.
This does not exist in today's medical practice.
Patients are now treated to a physician who is busy staring at a screen in order to check all of the required boxes in order to meet the insurance companies and the governments desires for a quality visit, so called bullet points. Let me be very clear. This has in no way improved the quality of care that I deliver. I am on average 10 - 20% less efficient in my daily visits. That is less people that I can help. I find myself apologizing to my patients for the computer time and my lack of eye contact at times. I find myself constantly trying to catch up and be on time with my visits. Remember that I used to see more people, chart and have more time to teach and educate each patient. That was quality care.
You may ask what is the point of all of this or that you do not really care.
The point is that for better or for worse the quality of the medical experience is eroding and is likely to do so for the foreseeable future. Doctors are much less happy with their career choice and that is translating into higher stress levels and increased numbers of physicians quitting general practice and going to concierge medicine or places like the VA where working hard is less common as noted in the recent press. (sad but true) It is my belief that patients will start to experience a divide in quality as the bright and frustrated move on to other careers or charge cash for services. It is happening every day.
Now, let me clear that I am not solely blaming EMR for this problem, however, it is a very large piece of the problem. It is just the current poster child for the decaying medical provider's experience and thus the patients as well.
I hope that you will forgive the parts of the system that are taking our eyes away from you. We are still paying attention and devoted to your child. I, personally, promise to try and remain calm if I get behind which seems to be weekly now. I will likely still apologize for the computer and ask for your indulgence. Somehow it makes me feels better.
Hoping for a revolution in providing care,
Dr. M
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