Paul Hyman, MD
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Hyman P.; The Day the EHR Died. Ann Intern Med. 2014;160:576-577. doi: 10.7326/M13-2749
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Published: Ann Intern Med. 2014;160(8):576-577.
I was sitting at the computer, reviewing a note in the EHR, when suddenly the software froze. I was just about to begin a full day in clinic.
I felt immediate frustration and anger. Each day in my job as a primary care physician is a race that I cannot finish to complete as much as I can from a long list of electronic messages, results, prescriptions, paperwork, telephone calls, and e-mails. For each minute I am unproductive at work, I know I will be working 2 minutes later that night after my family has all gone to sleep.
David L. Fairbrook, MD
May 7, 2014
I enjoyed your article,
The day the EMR died, when you had to actually talk to the patient without any computer driven information overload. It is a sad revelation that the EMR has failed to win over a scratch of note paper and listening to the patient. I am not surprised that you enjoyed the communication process without having to enter data, because that is what physicians are uniquely trained to do. The EMRs do not need tossing they need fixing. Ten years ago at a CME conference attended by ACP speakers, we physicians were told to take ownership of this new technology. We failed, hesitated, ignored the process and let computer designers, admin people and lawyers set up what they thought we needed. The Government did not set any expectations but threw it out to entrepreneurs to develop. The result was 200 plus EMRs on the market, all were interesting,none communicated with each other. Naive, frightened physicians had no way of knowing which one to choose. The Government finally recognized the problem and put in Meaningful Use criteria. Something they should have done in the first place. CMS, in their paranoia regarding abuse and fraud, then sent directives stating that, The Doctor is responsible for the HPI which chained the doctor to become the Data Entry Clerk. I have been following the EMR event for the past 10 years. My three provider Internal Medicine clinic served as a Beta site for and EMR company . I converted from paper to electronics during the last 20 months before I retired in 2008. It was a challenge, but very enlightening to experience the way medicine could be practiced in a way the would, save time, Improve efficiency and develop effectiveness. The EMR does not need tossing it needs fixing. Physicians are uniquely trained to: Ask open ended questions and listen to the patient. Analyze data and think outside the box. Provide medical decision making. Develop a care plan or diagnostic approach. That is what you so much enjoyed doing the day the EMR failed. The EMR stores and retrieves data, but the CMS directive that you are responsible for the HPI, does not allow for your health care team to provide all the Structural Clinical Data you need. The PMH, SH,FH med resolution can be entered by staff, reminders that are due can be ordered. Yet, by following the directives of CMS, the staff is not able to enter the elements and ROS of the Chief Complaint into the HPI. As you know the elements of the HPI are a series of closed ended questions of; onset frequency, severity, etc. as well as a series of yes/no questions concerning the complaint. Any decent EMR would have this information collected for every complaint from Anxiety to Xenophobia. This information could be easily entered through the Patient Portal, an I Pad in the waiting room, or with the help of your health care team. This and the vital signs, etc. is simple data entry of what I would call the Structured Clinical Data for the visit. The physician should spend his time with the open ended questions that fill in the history and allows him to understand the patients concerns and remain the Data Analyst not the Data Entry Clerk. When our Organizations support physicians to provide adequate feed back to designers, programmers and regulators. When physicians take ownership to express what they need and what the EMR should provide, then the profession can move forward to fixing the EMR rather than tossing it.
David L. Fairbrook M.D.
Class of 1969
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