Why Don't You Use a Computer?

I get asked every now and again by patients (usually while I'm writing in their chart) whether I plan to go to a computerized medical record.

I find that to be a really interesting question. Generally, I am a very enthusiastic computer user. I create web content, enjoy computer games, am versed in maintaining and securing wireless networks, and am proficient with several operating systems.

However, I have no plans to adopt "Electronic Medical Records" (EMR) unless they become far more useful than they are at present.

First of all, adopting EMR is shockingly expensive. Start up cost of adding new hardware, licensing software, training staff and doctors in their use and scanning existing paper records to EMR is about $50,000 in itself. This does not include future licensing or upgrades to equipment or software. It also does not include the 10-20% losses in income of the first 1-2 years of adoption due to a decrease in the number of patients that can be seen, as the implementation of EMR slows everything for 1-2 years.

Additionally, there is no widely accepted standard code set or open-source code for EMR. This means it is very easy to sink this kind of time and money into EMR for your office or group or hospital and be absolutely unable to use it to share crucial medical information with neighboring physicians simply because they using one of the other 10-20 most popular EMR platforms being marketed.

It should also be realized that EMR is not new, and has been around for a decade or two. It's intended primary use has never been to enhance the quality or consistency of medical care. Rather, it has been marketed as a way to fully document your visits in such a way as to justify your billing to insurance companies.

Unfortunately, EMR has not been fully re-vamped to optimize patient care and reduction of errors. Instead, features have simply been layered over and added on to the pre-existing systems. As a consequence, studies demonstrate that EMR does not result in improved care and actually results in increased error rates.

All of this may explain why the majority of doctors have not adopted EMR. A regular contributor to Kevin, M.D. nicely sums this up. You might not notice this here in Placerville, since Marshall has implemented an EMR system recently which can make it look like everyone now uses EMR.

I find it interesting that when I answer patient questions by saying that I don't plan to computerize my office the response is usually positive.

Most patients have commented that they find the use of a computer by doctors, nurses and physical therapists to be off-putting insofar as it limits conversation and eye-contact, and seems to take up time that would otherwise be spent examining or communicating with patients. I suspect they have a point here.

I'm sure it's possible to use EMR and not lose this human touch, but the current systems just aren't there yet and aren't likely to be there soon. I myself would rather not risk losing this element of human touch and communication with my patients.

EMR- Electronic Medical Records

20%
Percentage of doctor
offices using EMR


70%
Percentage of doctor offices dropping EMR
within 2 years of buying one


$65 Billion
Amount of money
being budgeted
towards national
implementation of EMR

I guess I'm not too hot on the concept of electronic medical records.

As a preamble, let me say that I own several computers, have installed my own wireless networks, enjoy using computers, have tried voice recognition software, and have beta-tested several EMR systems.

Bottom line, they do not save me time or make me more money. In fact, they can cost up to $40,000 to implement and take me longer to document what I do. They do not pay for themselves, and they do not help me to render better medical care than simply keeping and paying attention to a well-organized paper record. Plus, the paper record can still be used even if the power goes out, or the scheduling computer doesn't work.

I also note, that the EMR produced notes from many of my specialist colleagues that are often up to 4-5 pages of not much more useful information than I can get out of one page of well-organized well-written manuscripted notes.

As EMR systems become for comprehensive, they can actually start to make the job harder: for example, not permitting me to list a strong family history of breast cancer on the master Problem List. Like many other features of medical care, a system created by non-doctors and non-nurses may not be particularly effective or easy to use by doctors and nurses.

Also, there is no agreed upon code standards, so none of these expensive systems is capable of interfacing with other systems.

Believe me, I would enthusiastically embrace a system that allowed me to do my work faster, better and more efficiently that was affordable and as universally used as Microsoft Windows. I doesn't yet exist.