Time to rethink EMRs

Thomas Hall

doi:10.1503/cmaj.1150033

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Response to Dr Thomas Hall Letter re EMR Use
Andrew Murray MBChB MCISc (FamMed)

Posted on: 03 June 2015
EMRs - follow the money
Andre C Piver

Posted on: 29 May 2015
Time to Rethink EMRs - Improve Usability
Darren A Hudson MSc MD FCRP(C)

Posted on: 28 May 2015

Posted on: (3 June 2015)
Page navigation anchor for Response to Dr Thomas Hall Letter re EMR Use
Response to Dr Thomas Hall Letter re EMR Use
Andrew Murray MBChB MCISc (FamMed)
I have some questions for Dr Thomas Hall and some comments.
Dr Hall supports the use of evidence in decision making. 1. Dr Hall states that evidence showing that EMRs improve medical outcomes is thin. Is there evidence that the use of paper based charts improve medical outcomes or result in better outcomes than the use of EMRs? I really do not believe that EMR use reduces the quality of medical care for individu...
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I have some questions for Dr Thomas Hall and some comments.
Dr Hall supports the use of evidence in decision making. 1. Dr Hall states that evidence showing that EMRs improve medical outcomes is thin. Is there evidence that the use of paper based charts improve medical outcomes or result in better outcomes than the use of EMRs? I really do not believe that EMR use reduces the quality of medical care for individual patients nor for healthcare as a whole. 2. Dr Hall states that EMRs are a distraction. What is the evidence that EMRs is a distraction? Also, I wonder if there is evidence that rifling through paper charts or calling the lab or X-ray department for reports, and waiting for it to be faxed to the clinic, is not equally a distraction? I do not find my EMR a distraction at all and I think the patents understands that using an EMR is a necessary part of a consultation. 3. Dr Hall states that doctors spend more time looking at computer screens than at their patients. What is the evidence that doctors spend more time looking at computer screen than at their patients? Also, is there evidence that physicians who use paper charts spend relatively more time looking at their patients? Needing to look at a computer screen from time to time during the office visit is somewhat of a problem but can be managed with the way the computer is placed and by making it a practice to often look at the patient while taking the history. 4. Dr Hall states that the US has the best computerized medical system in the world and far worse medical outcomes that most other induction nations. What is the evidence that the high use of EMRs in the US is the cause of (a) their high cost of care and (b) their alleged poor patient outcomes?
I personally found paper charts hugely inefficient and ineffective. I find working with my EMR make my life so much more pleasant; as a matter of fact I intensely disliked paper charts; probably partly due to having to look daily at my terrible handwriting but mostly because I could only read about 30% of what other doctors had handwritten. Reports were tough to locate in 2 inch think files. I personally think my patient care is better because of my use of "my" EMR; my records are much better and my access to information is much better. It is hard to set it up initially and expensive but the provincial program in BC paid for most of it (cost of doing business and really not that large a cost anyway). I have used my EMR now for many years and it is very easy to maintain. It does not save me any time and I am not sure if I am financially better off. However, when I walk out of my office I now feel good because my records are legible and accessible and useful to me and to others who may need to use it. I think it is a wonderful clinical instrument.
You have to get past the steep learning curve. The days of not having an EMR is past forever for all physicians I think.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (29 May 2015)
Page navigation anchor for EMRs - follow the money
EMRs - follow the money
Andre C Piver, Medical Doctor
When "big data" is ever more valuable in order to crunch and usually rationalize cutting more front line services, it is predictable that apparently time-saving "smart" drop-down menus and templates have started to further standardize and limit the quality and colour of the medical record narrative. Once upon a time at least, Family Medicine, attempted to capture the complexity of real patients and their contexts. Fur...
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When "big data" is ever more valuable in order to crunch and usually rationalize cutting more front line services, it is predictable that apparently time-saving "smart" drop-down menus and templates have started to further standardize and limit the quality and colour of the medical record narrative. Once upon a time at least, Family Medicine, attempted to capture the complexity of real patients and their contexts. Furthermore, given that the IT sector has a vested interest in future work, it is predictable that patches in their operating platforms are ever less intuitive or consistent and lead to more patches. EMR's are useful for ease of access within a network and the ability to capture trends in investigation results but otherwise clearly interfere with the doctor patient relationship. They serve top-down management of very individual and idiosyncratic interactions as if they were being applied to an entirely quantifiable engineered product. Monitoring statistical trends and epidemiology is of great value but has no place monopolizing the doctor-patient interaction.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (28 May 2015)
Page navigation anchor for Time to Rethink EMRs - Improve Usability
Time to Rethink EMRs - Improve Usability
Darren A Hudson MSc MD FCRP(C), Physician and Adjunct Assistant Professor
Dear Editors;
I agree with Dr. Hall in principle on most of his points, I fear he has drawn a false analogy (1). The United States HITECH Act of 2009 was enacted to mobilize information technology to reduce an already skyrocketing healthcare system (2). If I may expand on his other points:
The distracting effect of electronic health records on the physician patient interaction are well known. This is...
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Dear Editors;
I agree with Dr. Hall in principle on most of his points, I fear he has drawn a false analogy (1). The United States HITECH Act of 2009 was enacted to mobilize information technology to reduce an already skyrocketing healthcare system (2). If I may expand on his other points:
The distracting effect of electronic health records on the physician patient interaction are well known. This is usually due to the usability of the EMR interface. Most systems are not designed for the patient encounter and vendors are reluctant to customize their systems for physician's workflow.
It is well known that EMR do not reduce healthcare costs nor increase efficiency. Poor usability decreases efficiency as well as frustrate the user. The actual benefits of EMRs are likely unmeasurable. Recently the American Medical Informatics Association have called for a re-evaluation of economic analyses in health IT (3) with a focus on the quality and patient safety benefits. EMRs can improve patient care even without cost reductions. I believe it would be a patient care disaster if we lost our provincial EMR (NetCare) to save money.
Finally, I would also echo Dr. Hall's comments about lobbying administrators and politicians about the use of EMR. We are past the tipping point but, as an important user group, it is vital that we continue to loudly advocate for usable systems that will allow increased efficiencies and not diminish the patient physician relationship.
References
1. Hall T. Time to rethink EMRs. Can. Med. Assoc. J. 2015 187:602
2. Crownover K.Implications of the HITECH Act of 2009.Caring. 28(7):40-2, 2009 Jul.
3. Riskin L; Koppel R; Riskin D.Re-examining health IT policy: what will it take to derive value from our investment?. Journal of the American Medical Informatics Association. 22(2):459-64, 2015 Mar.
Conflict of Interest:
I am the associate Medical Director for the eCritical Alberta Critical Care Information System and have a Masters degree in Health Information Science from the University of Victoria, where I also have an academic post.
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Competing Interests: None declared.