Last week, someone shared with me this amazing video and I have been singing along all weekend. There is quite a bit of skepticism in the lyrics to “EHR State of Mind” but it’s a clever expression of a physician’s view of the shortcomings of using EMRs. I enjoyed the creativity of this song and the video and I hope that these EMR issues are addressed soon as the frustrations he shared are definitely unintentional.
I have highlighted some of my favorite lines from the song below and wanted to share my interpretation from an HIM viewpoint.
“Notes used to be our story…narrative…but replaced with copy-paste…now a bloated ransom note”
This statement really resonated with me and my experiences over the past several years. I have definitely seen the decline in the quality of documentation since the install of the EMR. It doesn’t matter what vendor product is used, the reality is that the documentation has severely suffered because we’ve shifted the physicians’ attention to other workflow processes and EMR checkboxes. Copy and paste has reared its ugly head in far too many charts and we must stop the madness! HIM professionals have stepped in to assist with this by providing real-time auditing and feedback. Plus, HIM has provided assistance by enhancing documentation tools.
“Just a glorified billing platform with some patient stuff tacked on.”
I have heard similar statements on many different occasions. Some EMRs were structured around automating billing processes but that doesn’t mean they have to lack in clinical functionality. From the HIM perspective, we are accustomed to reimbursement and clinical documentation going hand in hand. Coding and billing processes were in need of an overhaul to make for more timely reimbursement and EMRs promised to do just that. Having the clinical documentation and data built into the same system was revolutionary and very exciting for us but it’s still a work in progress to optimize the clinical documentation.
“Uncle Sam promoted it but gone is the interop.”
Wow- this is sad but true. I remember when I first heard about EMRs, HITECH, and Meaningful Use. I had dreams of sharing data with anyone involved in a patient’s care regardless of geographic location through an EMR health information exchange. Unfortunately, this hasn’t even been possible within the same zip code and sometimes not even among providers in the same organization. True interoperability is definitely missing from our EMR systems.
And lastly, “Crappy software some vendor made us.”
Out-of-the-box EMRs are not a one size fits all by any means. EMRs must be customized, trained on, and implemented in a fashion that works for each provider and healthcare system. The implementation process is not complete at “go-live”. The optimization (and most likely, re-build) period must continue indefinitely until the EMR workflows and data capture are ideal for all patient care, quality reporting, and billing purposes.
Do we really need a “new chart” or is enough optimization possible to get us where we need to be? We are constantly having discussions, starting committees, releasing updates, running reports, and everything in between with hopes that our enhancements will make the EMR more functional and meaningful. I value the feedback from physicians and other clinicians who are using the system daily because their intentions are to deliver the best patient care. EMR obstacles are unacceptable and must be fixed with the help of skilled EMR specialists, HIM and IT professionals, and workflow experts.
Enjoy the video by Dr. Z.
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John, Thank you for sharing…much truth to be said here. I too come from this environment fraught with frustration over the EHR which has yet to improve the quality of patient care. The EHRs benefit is not in improving quality today, but in providing the necessary transparency so that leadership can see where things need fixed so they can ‘reign in’ on practice variation or bad practice. True that hospitals have spent WAAAAYYYYY too much money on these over-inflated systems that boast the worst user interface experience of any systems on the market. The word E#R is more like a swear word among the industry, than a positive term. There is certainly far too much emphasis on the ability of the EHR to save the world, but in order to change that, we (society) must better define what a good system looks like, so that one can be developed. I think we can all agree that today’s system will not last the test of time; their IT infrastructure and architecture is not robust enough to achieve the end goal.
I have been following your blog for months and enjoy it very much. Keep up the great work!