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Living with the dinosaur
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It’s not that I’m so old (God forbid) or nerdy (ditto) , but over the last 6 or so years I’ve had occasion to seriously dig in to four to six different electronic health record (EHR) systems — both major and minor alike. With my primary medical group’s current EHR, I am thoroughly convinced that we as a profession embraced technology in medical records long before technology was truly ready for us.
Medical models of patient care are abound, and include many forms of diagnostic and treatment algorithms, patient-centered care, patient management tools, etcetera. However, each provider approaches patient care in a unique way — similar to the way that people use their computers in their personal lives differently from one another. Some create huge networks of information and record sharing, some focus more on the interconnectedness of their own information or documents, and some harness the power of the computer to reach out to communicate with others in written, audio, visual and now virtual ways. The point is: Computers today are capable of molding and flowing to accommodate what the user brings to the table, moldable to what the user wants to produce, can be driven by how the user “sees” life and can be directed to “create” accordingly.
Not so with electronic medical records (EMRs). EMRs remain the dinosaur in our medical lives. EMRs are typically designed to follow logical thinking — logic in treatment plans, patient flow charts, decision-making algorithms, cross-linking information — but are not designed to follow the people flow, the flow of thought, the flow of instinct, the flow of training, the flow of the patient. Sure, you can get there from here, but you have to go through six or so steps to adequately communicate this information to your computer and document it appropriately.
It’s a little bit like the DOS to Windows analogy. Not that Windows is the only successful operating system, but even moving to the new operating system was a paradigm shift in the computer industry that was sorely needed to make computers accessible and interesting to all but the DOS and programming geeks and nerds. We are a little in this phase of EMR.
The best EMR systems at this point are cumbersome at best. They require more and more participation on our parts to create less and less point of care face-to-face service. Sure, they connect information, but not really as efficiently as our brains do — as witnessed by the myriad clicks, pushes, drags and selections needed to get to what we really want to know or do on our systems. In most clinics where EMR has been successfully and fully implemented, patient face time goes down, provider computer time goes up, and we add more, and more, and more keystrokes to get to where we want to go. And when we finally get there, we look at the pathway we created and say, “Hmmm. That’s not exactly what I wanted here.”
EMRs are still a wonderful concept, and I do believe they have the potential to change the face of medical care in a positive way. However, I am also convinced that we have implemented a dinosaur – one that will continue to grow into a behemoth until a paradigm shift in product development for the medical profession really occurs. We need a DOS to Windows paradigm shift — or maybe you have an even better analogy. In the meantime, we will seek, scan, point, click, drag, highlight, enter, tab and type — and I’ll be surprised if you don’t need a new pair of glasses like the rest of us this year.