Category: books, literature, arts

The electronic medical record-asset or annoyance?

The increase in physician burnout has been directly linked to the introduction of electronic medical records.

You’re probably used to your doctor’s office using an EMR, electronic medical record (also called EHR, electronic health record) . By now most clinics, private medical offices, hospitals, labs, imaging centers, and other healthcare settings use computers exclusively for everything from scheduling, communication, to documentation and billing. If you are a young adult, you may not even remember a time when medical offices and hospitals used paper records.

Medical Record
Do you remember the stacks of charts in doctor’s offices and hospitals?

Dr. Danielle Ofri, author of several books about healthcare delivery, wrote an astute opinion piece about EMRs for STAT which I encourage you to read. I’m going to review her post adding my own ideas, , with the goal of helping you understand why we doctors, and maybe you, have a love/hate relationship with computers in healthcare; as Dr. Ofri says about electronic health records,

they all have their breathtaking assets and snarling annoyances

Dr. Danielle Ofri

In her piece, Dr. Ofri refers specifically to the use of electronic records in hospitals, but the issues are similar in clinics and other settings.

Breathtaking assets

  • more efficient storage of records than paper (taking up less physical space and time for sorting and filing)
  • ability to generate reports
  • improved hospital efficiency and financial margins (possibly by the ability to analyze data and generate reports)
  • able to analyze the health needs of large numbers of patients, called population health, so health systems can plan for and offer needed services more efficiently
  • communication- the ability to contact doctors by email, get test results through a portal, schedule appointments online, order med refills, etc.
  • legibility and standardization in documentation

Snarling annoyances

  • changes the way doctors work and make decisions; current software often does not reflect the way doctors are taught to approach patient diagnosis and treatment
  • less efficient retrieval of data than paper (due to larger amounts of data, which may be redundant)
  • little evidence yet that use decreases complication rates, or improves patient care in general
  • less personal interaction with healthcare professionals when communicating through a portal
  • increased time spent documenting on a computer , much of it simple data entry, compared to writing on paper

But the greatest disadvantages attributed to the use of computers in the medical setting, ones far more than “snarling annoyances” are

  • interference with doctor patient interaction and communication in the office or bedside; both doctor and patient may pay more attention to the computer than to each other
  • erosion of staff morale, often due to more time spent on the computer than with the patient, boredom with data entry, and stress of having to learn new systems and updates
  • contributing to physician burnout, which can have a negative impact on patient care

Doctors like me, who did not grow up in the computer age, went through the entire medical education experience without touching a computer. For us , the transition to computerization while maintaining a busy schedule of patient visits, was difficult and stressful. The increase in physician burnout has been directly linked to the introduction of electronic medical records.

Boldly going…

As Dr. Ofri points out, the EMR is not going away, and few if any of us want to go back to the old system, as annoying as the new system can be. The annoyances are slowly being worked through and resolved, and the assets are becoming truly helpful.

The younger generation of doctors who have never known a world without computers embrace their use readily. As we senior doctors wind down and eventually retire, we can pat ourselves on the back for being the generation that led the way into this strange new world.

a graphic showing various mobile computing devices
a graphic from the LIGHTSTOCK.COM collection, an affiliate

Where you, the patient, fit in

You as a patient have a stake in this endeavor too. As already mentioned, being able to access your records, make appointments, manage payments, and send messages on your computer or mobile device brings efficiency and convenience to a process that formerly was time consuming and cumbersome. I now routinely use my doctor’s office portal for my own medical needs and my patients use my office’s online services . Here’s what you can do to help make EMR use better.

  • Use whatever online healthcare resources available to you. The more we all use them, the easier they will be to use, and feedback will help developers make them even more helpful.
  • Be patient with your doctors and other healthcare providers as they transition to EMRs, from one to another, or when problems occur. Like any piece of technology, they don’t always work perfectly, and occasionally they don’t work at all.
  • Give constructive feedback. A thoughtful critique will help more than irate criticism.

Here is the link to Dr. Ofri’s article-

The EMR has changed the doctor patient relationship into a menage-a-trois

“you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you. ”

from my review of Dr. Ofri’s book -at this link

What Patients Say, What Doctors Hear

Danielle Ofri, M.D., is a physician at Bellevue Hospital, a clinical professor of medicine at the New York University School of Medicine, editor-in-chief of the Bellevue Literary Review, and author of the forthcoming book

When We Do Harm: A Doctor Confronts Medical Error

Another physician explores the EMR

MAN’S 4TH BEST HO$PITAL By Samuel Shem

Samuel Shem (pen name of Stephen Bergman, M.D.) is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His other novels include The House of God, Fine, and Mount Misery .

In this novel about a hospital dominated by computer screens and corrupted by money, an idealistic doctor has one goal: to make medicine humane again. Here is an excerpt-

“Cynical? me? I feed on ideals, on ideal care. I’m so idealistic, to you I sound cynical! And I do not call ’em Electronic Health Records, ’cause they don’t help with health, and may well harm it. With a screen between you and your patient, you get distracted, right? It’s like texting while driving.

So, to remind us of the danger let’s call ’em EMRs, the ‘M’ for “Medical’. “

After a student asks why the computer systems at the VA (Veterans) and the Indian Health Service hospitals, both government agencies, are more user friendly, he goes on to explain,

“Nobody’s makin’ money offa it. So we all gotta get together and unhook care from billing. So nobody makes an obscene profit offa the sick.”

available on Kindle (affiliate link)

exploring the HEART of the health record

I hope you found this discussion enlightening; maybe it answered some questions you had about electronic health records and maybe raised some issues you’d like to know more about. Please contact me with questions and I’ll answer them in a follow up post.

Dr. Aletha
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Living life, facing death-a review of A Beginner’s Guide to the End

Even as a physician, I was surprised at the claim that only 10% to 20% of us will die without warning. The rest of us will know we have something that will likely take our life. And even if we don’t, we all know we will die eventually, although we tend to think and act as if it’s a well kept secret, and maybe it is.

by B.J. Miller, M.D. and Shoshana Berger

This book’s tag line sums up the content of this book perfectly. I have reviewed other books about death on this blog; they were more biographical, philosophical, and spiritual and touched less on the practical. This book is on the other end of the spectrum; more practical, but also philosophical ,and spiritual. ( And I mean spiritual in a broad sense, not necessarily religious.)

The book begins with a brief biographical section where each author shares their reason for writing a book about death. Dr. Miller, a palliative care physician, had a life-threatening injury. He writes,

I got close enough to see something of death and come back from the ledge, only to realize that it’s in and around us all the time.

Ms. Berger, an editorial director, took care of her dying father. She wrote,

I remember those years as being full of anxiety and grief but also as a time of drawing closer.

an illustration from the book

How the book unfolds

The book consists of 5 sections that mimic the progression from life to illness to death. Even as a physician, I was surprised at the claim that only 10% to 20% of us will die without warning. The rest of us will know we have something that will likely take our life. And even if we don’t, we all know we will die eventually, although we tend to think and act as if it’s a well kept secret, and maybe it is.

The sections are as follows

  • PLANNING AHEAD
  • DEALING WITH ILLNESS
  • HELP ALONG THE WAY
  • WHEN DEATH IS CLOSE
  • AFTER

Although you could read the book straight through, you might want to skip to sections you need at whatever stage you are in. Chapter titles clearly tell you what to expect from their content. Here are some examples-

  • Yes, There’s Paperwork.
  • Can I Afford to Die?
  • I’m Sick
  • Love, Sex, and Relationships
  • Hospital Hacks
  • Care for the Caregiver
  • It’s Your Body and Your Funeral
  • Grief
  • How to write a Eulogy and an Obituary
  • Celebrating a Life

There are no photographs, charts, graphs, or info graphics, but scattered throughout are illustrative sketches that convey helpful information in a non threatening way. I have used some screenshots of a few of them to illustrate this post.

The authors conclude the book with Last Words, Acknowledgments, Resources (an extensive list), Notes, and Index.

Read this book

As much as I hope you don’t need it right now, unfortunately you do need it right now. So whatever stage of living, or dying, you or a loved one may be in, you will find something helpful here.

Find the book at your local library like I did, or get it from one of these book sellers; this would be a good book to keep on hand. (These affiliate links pay a commission to support this blog, while you pay nothing extra. )

Dr. Miller’s TED talk on WHAT REALLY MATTERS AT THE END OF LIFE

Here is another post from this blog about the dying experience

What books teach us about dying

an excerpt-

I reviewed these books  because understanding how other people and their families have faced death may relieve our dread, anxiety, or fear  about dying and death. Often it is not death itself that we fear but the dying process -the pain , disability, dependence, isolation, unfulfilled dreams.

In an essay  for JAMA, Dr. Zachary Sager, a geriatric and palliative care physician in Boston Massachusetts, described his response to  working with dying patients-

“I witnessed how people could be simultaneously resilient and fragile. I was moved by the connectedness between individuals.

I accept that death offers not only the expected reflection on life and mourning but an opportunity for a unique form of growth and healing. ”

The books I reviewed share  common themes, and events yet are each unique as are the people in them who demonstrate both resilience and fragility.

sharing the HEART of life and death

Dr. Aletha