0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
On Being a Doctor |

The Day the EHR DiedThe Day the EHR Died

Paul Hyman, MD
[+] Article and Author Information

From Cambridge Health Alliance, Cambridge, Massachusetts.

Requests for Single Reprints: Paul Hyman, MD, 454 Broadway, Revere, MA 02151; e-mail, phyman@challiance.org.


Ann Intern Med. 2014;160(8):576-577. doi:10.7326/M13-2749
Text Size: A A A

I was sitting at the computer, reviewing a note in the electronic health record, when suddenly the software froze. I felt immediate frustration and anger.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
comment
Posted on May 7, 2014
David L. Fairbrook, MD
Retired
Conflict of Interest: None Declared
Dr Hyman,
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

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)