E-Patient Update:  When EMRs Didn’t Matter, But Should Have

The other day I went to an urgent care clinic, suffering from a problem which needed attention promptly. This clinic is part of the local integrated health system’s network, where I’ve been seen for nearly 20 years. This system uses Epic everywhere in its network to coordinate care.

I admittedly arrived rather late and close to when the clinic was going to close. But I truly didn’t want to make a wasteful visit to the ED, so I pressed on and presented myself to the receptionist. And sadly, that’s where things got a bit hairy.

The receptionist said: “We’ve already got five patients to see so we can’t see anyone else.” Uncomfortable as I was, I fought back with what seemed like logic to me: “I need help and a hospital would be a waste. Could someone please check my medical records? The doctors will understand what I need and why it’s urgent.”

The receptionist got the nurse, who said “I’m sorry, but we aren’t seeing any more patients today.” I asked, “But what about the acuity of a given case, such as mine for example? Can’t you prioritize me? It’s all in my medical records and I know you’re online with Epic!”  She shook her head at me and walked away.

I sat in reception for a while, too irritated to walk out and too uncomfortable to let go of the issue. Man, it was no fun, and I called those folks some not-nice things in my mind – but more than anything else, wondered why they wouldn’t look at data on a well-documented patient like me for even a moment.

About 20 minutes before the place officially closed for the night, a nurse practitioner I know (let’s call him Ed) walked out into the waiting room and asked me what I needed. I explained in just a few words what I was after. Ed, who had reviewed my record, knew what I needed, knew why it was important and made it happen within five minutes. Officially, he wasn’t supposed to do that, but he felt comfortable helping because he was well-informed.

Truthfully, I realize this story is relatively trivial, but as I see it, it brings an important issue to the fore. And the issue is that even when seeing chronically-ill patients such as myself, whose comings and goings are well documented, providers can’t or won’t do much to exploit that data.

You hear a lot of talk about big data and analytics, and how they’ll change healthcare or even the world as we know it. But what about finding ways to better use “small data” produced by a single patient? It seems to me that clinicians don’t have the right tools to take advantage of a single patient’s history, or find it too difficult to do so. Either way, though, something must be done.

I know from personal experience that if clinicians don’t know my history, they can’t treat me efficiently and may drive up costs by letting me get sicker. And we need more Eds out there making the save. So let’s make the chart do a better job of mining patient’s data. Otherwise, having an EMR hardly matters.

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.


  • Well said. It absolutely amazes me in our business where we transfer tens of thousands of records to the patients themselves, how many tell us that when going to a new doctor (GP), that new doctor will refuse a copy of the historical record in favour of starting a brand new one along with asking some questions to the patient. It seems that humankind has a resistance to “learning from history.”

  • Also, well said. I would add that some in the ‘urgent care clinic’ world, EMR’s seem to be mainly for billing, since, ‘who would keep going to one’ instead of normally going to their own doctor. Of course, real world is urgi centers tend to have somewhat better hours, and a few, at least are actually part of ‘real’ hospital and related system networks. The records really count. However, some undertrained ‘receptionist’ type at the front desk who doesn’t understand what this is about, that there are emergencies that fall short of the need for an ER, and that the place is part of a system rather then just a ‘drop in’ center, won’t understand or care about what the would be patient is saying.

    I tend to have a ‘thing’ against urgi centers, since most around me seem to ooze with mediocrity. My ‘favorite’ used to generate 911 ambulance calls on patients at least once or twice a day since the so called ER doctors in it couldn’t handle anything close to a real emergency. I dispatched some of those ambulance calls (as a volunteer for the local ambulance corp). In one case, our medical director heard such a call on his radio from a block away, and arrived to find a cardiac patient just dumped on a stretcher in a back room unattended since they were clueless on how to help the patient. IOTW, at least in some of these urgi centers, there can be a real atmosphere of incompetence and ‘who cares’, that it’s just for the money rather than real medical care.

    Even in an urgi center, there should ge ‘triage’. It can’t safely be about time of day, or who got there first, but rather who needs and can benefit from actual urgent care. But this attitude still exists in many practices, not just urgi centers. You call in with an emergency, say a broken arm, and they offer you an appointment to do the cast in just 8 weeks!

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