Are EMRs Harder To Use Than Paper?

A couple of days ago, one of our readers made an interesting comment on the ways in which he feels that EMRs are a painful distraction from the practice of medicine:

In the trenches, this stuff pulls us away from our patients, gobbles precious mindshare, and is sometimes downright dangerous. And it’s not just click counts that are the problem. Every unintuitive click or unnecessary checkbox steals something away. It might be the way a pain was described, or the look I was given as I left the room, or the 6th critical thing I am remembering in a long list of critical things. But once I am clicking away, it is gone, to the detriment of my patients.

My colleague, John, responded by asking the poster whether these problems are really unique to EMRs, or whether there are equivalent distractions that arise when physicians use paper charts.  Not being a doctor myself, I can’t offer the final word on this subject, but it might be interesting to compare the two side by side.

Below, I’ve outlined what I  see as some of the key head-to-head comparisons we should consider when comparing paper charting to EMRs. I’d love to know whether you agree with my conclusions, or have more to add.

-Anne

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 Style of recording information

Paper:  Within standard limits, allows for free-text entry of whatever data the doctor would like to see recorded
EMR:  Doctors must work with checkboxes, at least to some degree, and can only enter free text in prescribed areas

Advantage:  Paper

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 Finding historical data

Paper:  If a doctor wants to find historical information, he or she must flip through previous pages; if the previous caregivers were precise and wrote neatly this may be fine, but if they didn’t this could led to confusion or inaccuracy.

EMR:  If indexed well, EMRs make easy to find historical information, and by definition there’s no problem with reading illegible handwriting.

Advantage: I see this as a toss-up. Paper systems are familiar and in their own way, efficient when searching patient histories. EMRs offer legible — and if the data schema makes sense, easy to find — historical data. This one’s a matter of taste to some degree.

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Capturing physicians’ experience accurately

Paper:  The poster’s comments suggest that using paper allows him to directly and effectively record his impressions of patients as he gathers them.

EMR:   Many doctors, not just the one commenting above, see the process of adapting to EMR workflow as an intrusion which takes them off their game and deprives their observations of the accuracy and richness of paper records.

Advantage:  Paper. From what I’ve seen so far, there’s a lot of truth to the complaint that EMRs force doctors into workflow patterns which distract them, prevent them from working on intuitions of the moment and force them through routines that add no real value.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

5 Comments

  • Anne – I appreciate your head-to-head comparison of paper to EMR data recording. Paper is definitely more intuitive and provides quicker input, and EHR provides quicker access, retrieval and sharing. How about a system that takes hand writing, converts it to discrete text, enters it into the EMR system and (can you believe it?) meets meaningful use criteria? This is what a new digital pen and paper does. I think your readers might be interested in this opportunity to continue to use pen and paper and still qualify for the EHR incentive.

  • What is the purpose of and EMR (electronic medical record)? It allow easy tracking of patient outcomes by the Government, Insurance companies and other institutions including the doctor.

    What helps an EMR be a good one? It is important for the EMR to be user friendly and provide safety in use. A good EMR is easy to use especially when documenting values that are normal, and help offset extra time by creating shortcuts for these normal values. Default usual dosing of medication is important to help the doctor avoid prescribing too little or too much, and will point out interactions of drugs to the doctor to help make the doctor aware of alternative medications.The system should be up to date, respond quickly and integrate with other parts of the system such as Radiology imaging, signing records, and checking lab values from prior visits, and integrate with other EMR systems from physicians offices,especially those systems that the hospital set up for the doctors offices.

    Why is this important to the patient? Doctors that spend too much time finding and documenting this information can compromise the time spend taking care of the patient. A good system should be instituted in a phased in manner to allow the physicians and support personnel to become comfortable with the system. Those doctors who cannot adapt need to be given extra support by the Hospital or in the Outpatient setting to offset these problems. It is the Hospital systems responsibility to provide the best system possible and the greatest support possible to assure good patient care by the personnel that use it.

    What are the deficiencies of HCA with their current EMR? Their EMR is ancient dating back prior to 1985 and sorely requiring revisions that the administration is unwilling to provide. Although it is a temporary system, it is expected to be in place for 5 years. The language is as old as DOS and is pieced together as 5 parts that communicate slowly. The Radiology, Permanent EMR record, financial systems, EMR writer, and laboratory values are all separate systems that make for slow response.

    To add to the problem is an administration in Tennessee that only thinks in dollars and cents. They find it too costly to invest in this “temporary” system with the integration of physicians and IT personnel to make it work better. No default values for usual medication dosing. Difficulty in reviewing old medical consultations, lab values, and radiology. Poor template default values for normal exams, and poor ability to communicate information in the physician notes to other doctors. IT personnel are slow to institute change and many changes appear to be without physician input. The outpatient EMR system that they have supported for their doctors does not integrate with their EMR system.

    Word to characterize their system: Cheap Inefficient, Outdated, Slow, Poor integration, and Poor support. This combination makes it unsafe for patient care regardless of the quality of the physicians using it.

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