Why Electronic Medical Records are hated by doctors and nurses

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at Medicine for Real – one of our top ten healthcare blogs. This post was so good I don’t see how to summarize it – please read the original here A Top Ten List for EMR and subscribe to Medicine for Real – Dr. Leng will give you an insider’s perspective on healthcare – as practiced at the top level. You don’t want to think about what goes on at the “average hospital”.

February 14, 2013
Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.

No wonder everyone hates electronic medical records (EMR)! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it. Nevertheless, here’s my wish list for a system that doctors would actually want to use:

1. ELIMINATE THE USER NAMES AND PASSWORDS. You can’t tell me that in this day of retinal scans and hand-held computers that there isn’t a better way to secure data. What if each person had their own iPad that you only have to sign into ONCE a day that automatically signs your charts. If you’re worried about people leaving them sitting around use a retinal scan or fingerprint instant recognition system.

2. ELIMINATE THE PAPER. If you’re going to have full-time people entering data for you, why print it out? It’s on the computer for anyone to access.

3. ALL DATA SYSTEMS MUST BE COMPATIBLE. You can’t have patient data entered in one place that doesn’t automatically import into another place. If my anesthesia record can’t talk to the hospital OMR, I have to RE-TYPE everything in, which is completely ridiculous.

4. EVERYBODY HAS TO USE THE SAME SYSTEM. Everybody, state-wide. Right now, electronic records from a nearby hospital are not available at my hospital, even though the two hospitals are right across the street from each other.

5. DON’T MAKE ME TURN THE PAGE. All the important information about a patient should be on the first page you open when you look up a patient. I shouldn’t have to click six different tabs. Specific to anesthesia, all the relevant data about the patient including what medications they have received during the case should be automatically displayed on the screen when you start a case. Specific to primary care, all the latest labs and data, recent appointments with specialists, current med list and anything else the doctor wants to see commonly should be right on the first screen.

6. DON’T MAKE ME HAVE TO REPEAT MYSELF. If I do eight cases the same way, with the same documentation required for each case, I still have to enter that documentation each time. If I’m seeing 20 patients in primary care clinic and the rules require the same documentation for each person, I shouldn’t have to enter that documentation each time.

7. INVEST IN DEVELOPMENT OF REALLY GOOD VOICE-RECOGNITION SOFTWARE. If I’m sitting across from a patient, I want to look at them and talk to them, not talk to them and look at a computer screen. If my mother didn’t make me take typing in high school, I don’t want to have to spend 3 hours after-hours every evening pecking my conversations with my patients into a computer, or worse, checking boxes electronically.

8. GET RID OF THE WIRES. In this day of wireless, why am I still tripping over monitoring wires and untangling cords? My spin bike at the gym can pick up my heart rate without a wire. Why can’t my anesthesia monitor?

9. IF YOU NEED A TYPIST, HIRE A TYPIST. Every time a new rule or documentation requirement pops up, which in my institution is daily, it is always laid on the nurses to add that to their computer records. Nurses used to be nurses. Now they are data-entry specialists. Their checklist and pre-operative paperwork is longer than mine. And they aren’t doing any diagnosis or treatment.

10. TRIPLE BACK-UP THE SYSTEM. Computers crash. Paper doesn’t. There’s got to be a way to make the system rock-solid reliable.

There are a mind-boggling number of rent-seeking interests in the US medical system. I would really like to know the true story of how Google’s effort to offer free EMR was defeated by these interests. Google knows how to build, operate and refine such systems at scale – and FAST. What we have now is a complete mess – which will take decades to rationalize.

2 thoughts on “Why Electronic Medical Records are hated by doctors and nurses

  1. The writer obviously understands the problems associated with electronic record keeping and has several suggestions which should be incorporated.

    Before I retired, I programmed computers for over 20 years. One of the problems is that all too often, computer programmer / analysts lack an adequate understanding of user requirements and fail to make the software as easy as possible to use. Part of the solution would be to hire end users as consultants during the software development process. Also, before the final release of the software, end users should have an opportunity to try it out and any problems they have either learning to use it or using it should be observed and addressed.

    There is entirely too much software that is excessively difficult to learn and use.

    Electronic medical record keeping has considerable potential to improve efficiency and reduce the number of errors. It would be unfortunate to throw it out just because software developers have done a bad job.

    • It would be unfortunate to throw it out just because software developers have done a bad job.

      Agreed, but I think the most likely cause of the silos of data (and hard to use software) is the institutional setting.  I’ve never seen elegant, standards-based software come out of a big bureaucracy, public or private. I.e., software that makes users literally excited and happy to use it. 

      In other words, I don’t think the best programmers could make a soufflé out of this situation. But Google did a wonderful job – they know the art of great software, great data and they are an anti-bureaucracy.

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