When The EMR *Is* The Problem

The other day, I sat in an office while a nurse practitioner entered data into an EMR.  The visit was a follow-up, so there wasn’t a lot to record, but somehow, it took a good 45 minutes nonetheless.  While the nurse’s long stenciled fingernails couldn’t have helped her typing speed much, the real problem seemed to be the EMR, which kept locking up and seemed to be harboring someone else’s data. (It had my weight at 50 plus pounds more than I am, a data problem to be avoided if you’re hoping to track patients for health risks.)

Now, I do think some of the responsibility for the crazy quilt of mistakes and processing problems can be laid at the feet of the nurse, who didn’t seem particularly well oriented to the system and as noted, clearly couldn’t have passed a high school typing test. I also doubt she had to mispronounce my name three times as she moved from one screen to another.  Clearly, she wasn’t big on bedside (office-side?) manner.

The thing is, I think she wanted to be helpful, wanted to be personal and most importantly, wanted to be careful with the interview and med prescriptions. The problem was, she was so embedded in the process of using the EMR that the higher purpose of having it there in the first place was all but lost. Though she seemed bright enough, the nurse had trouble compensating for the demands of the system.

The bottom line, as I see it, is that even if the nurse will never win any IT prizes, the situation was not her fault.  It was that the EMR absorbed all of the nurse’s attention and concentration, leaving me feeling somewhat peripheral to the situation at best. Yes, she could probably make some improvements in how she interacts with patients, but if taking her eyes off the screen means she forgets critical details, that’s not going to happen.

This experience left me wondering: How often are good clinicians being turned into distant, vexed and struggling professionals who barely acknowledge that the patient is there twiddling their thumbs?  And how can the health system afford this kind of timewaste and error-prone user patterns?  I don’t know the answer to either question but I think we should find out.

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.


  • I agree, it was not her fault. It’s due to lousy:

    User involvement
    Training and

    Other than those things I wouldn’t know what to fault.

  • Trying again to correct my website:

    The solution is to develop good EHRs that increase quality and increase productivity (Both of which would make for a better patient experience.)
    Current EHRs do not have this approach and do not neeed to to succeed, thanks to your government..
    The government has removed market forces by mandating that everyone get an EHR now. The ONC has brought us from 300 marginal EHR vendors at the beginning of Meaningful Use to 600 marginal EHR vendors now.
    The government makes everyone buy this stuff, while setting the lowest bar possible for entry into the market (My favorite is that MU requires a visit summary but does not require that document to have a summary of the visit). The administrators choose the system in order to get money from the government. And the actual users are told to use the system no matter how bad it is or to go to another hospital.
    Don’t expect better systems in the next decade, thanks to this Draconian approach to central planning.

  • Actually, it’s the opposite of a central planning approach. There are no penalty for the vendors if they do not comply, nor are they prohibited from marketing their goods.

    The MU system is quite much of a market driven approach where the government sets standards, but does not set functional requirements, that is, MU does not set out how the an EMR screen should look what should happen when you click this or that.

    If you look at how the FCC, for example, regulates communications devices you’ll see a far more centrally directed system. The Consumer Product Safety Commission regularly bans products and mandates recalls to prevent injuries. That’s far more in the realm of a classic type of regulation. Ditto for the SEC and EPA’s general approach to changing vendor behavior.

    I don’t care for much of how MU works, but to call it central planning is to make an inductive leap over a cliff.

  • I disagree; I think it WAS partly the nurse’s fault – for not being properly trained, taught to recognize that she needs better transcription and manner skills in order to interact with and be more efficient in working with patients … and with her supervisors for not helping her enough with those qualities. It’s easy to blame the EMR (and I’m sure that there WERE obvious tech issues) and forget that EMRs and EHRs are, at the moment, works in progress at most hospitals and clinics. But proper training, and empowering medical staff to succeed IN SPITE OF any tech issues that may come up, SHOULD’NT be “works in progress.”

  • This may sound silly and trivial, but the nails didn’t help. Extremely unprofessional, and perhaps a hint of her view of nursing and EHR usage. But I do blame her bosses for allowing it and for not making sure she was properly trained.

  • I’ve seen a lot of discussion recently where people are calling for MU, the government, or some other regulatory force to mandate a design for the look, feel, and interaction of EHR’s. I couldn’t disagree more with this line of thinking. It harms innovation and restricts designers from discovering new and improved user experiences.

    I’m not saying that there isn’t a need for some type of guideline for EHR’s when it comes to things like safety. Cars are required to have certain components up to a specific standard for the safety of the general population, if you’re brakes didn’t work you’d be a danger to yourself and others. In the same vein, an EHR needs to properly display a patient’s allergies to a user in a human readable format without error for the safety of the patient.

    There are applicable standards in usability that should be followed to maintain patient safety, privacy, and the like, but mandating how screen in an EHR should look, the layout of fields in a particular screen, what buttons should do, or how a workflow guides the user will only lead to even further stagnation in EHR design than we see now. There are even some questionable components in MU’s 2014 rule that small and specialty focused vendors will waste time implementing when they could be innovating. It’s MU and this regulatory design line of thinking that keeps vendors from creating exciting new ideas like those found in the health design challenge.

  • I will offer one potential explanation to the (hopefully temporary) problem. The EHR is probably not the problem!!- Rather it may be the training:

    EHR training projects are disastrously ineffective when training managers and supervisors lack fundamental knowledge of workflow analysis, effective curriculum design and pedagogy, effective teaching strategies and competency assessment techniques. It takes education experience coupled with Health IT knowledge to ensure a successful training curriculum. Usually, not all highly beneficial EMR/EHR features are thoroughly understood (some are misunderstood) before go-live. In addition, there are many clinicians that are not as comfortable with computers and do not benefit much from the rushed training in preparation for implementation. Yet few healthcare companies provide 1-on-1 or remedial training for their clinical staff.

    A good Training program must provide tactical oversight to plan, organize, and deliver training objectives, including orientation sessions for on-the-job training for system users. This is the focal point for creating/providing training methodologies within healthcare implementation guidelines. EHRs can improve a efficiency, outcomes, and productivity. However, if users are not trained sufficiently, not all the appropriate ROI benefits will be attained quickly.

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