I came across this tweet from Howard Green, MD that really made me stop to think.
@nickisnpdx We tell our kids to put down their devices and interact. We tell our doctors pick up EMR devices and stop interacting #EMR
— Howard Green, MD (@DermHag) August 11, 2016
I like the juxtaposition of his comment because it makes you stop and think about the decisions we’re making. Although, I think that Dr. Green takes it too far since no one ever asked doctors to stop interacting. In fact, the chorus I’ve heard is that doctors need to interact more with patients. That said, I get his point that the EMR can get in between the patient and doctor if you let it. And many have let it get in the way.
We can certainly talk about how EHR software could be more usable. We can talk about how the onerous regulations and things like meaningful use and MACRA have made documenting in an EHR a clickfest that provides little to no value to patients. We can talk about how EHR software isn’t connected to other EHR software and we’re living in this world of healthcare data silos. All of these are a pain and a problem for doctors and we should do better. What is unfair to say is that EHRs tell doctors to stop interacting.
It’s always amazing to me how the EHR gets all sorts of undeserved blame. I’ve seen plenty of doctors who use an EHR and still spend plenty of time interacting with their patients. In fact, people like Dr. James Legan have integrated their EHR use into their patient interaction and made their patient interaction better. Yes, the EHR can be a distraction, but it doesn’t have to be. The same way devices can ruin my children, but they don’t have to ruin them. It’s how you choose to use it.
This is a topic of much debate in the industry. Personally, I like to see a doctor putting information in an EHR while I speak to them – it tells me that they are capturing it and paying attention – as opposed to the concern that they will forget everything I said after they leave the room
Re “the EMR can get in between the patient and doctor” for various reasons, “if you let it” being a lesser reason IMO.
MU has to pick up a lot of the blame as a result of excessive focus on long-term outcomes data collection and not enough focus on clinical workflow and inter-operability.
The cascading effects have been:
1. docs/clinics/hospitals only buy certified software.
2. vendors only work on certifying their software.
Nowhere in here were docs/nurses consulted on the workflows they need to properly attend to patient needs, so, not unexpectedly,
3. the software does not do a good job mapping to clinical workflows.
Too bad no one figured out in advance that the best folks to specify the way the software should work would have been the end users, not the regulators, not the vendors.
I agree with Karl,
We use a non-certified custom EHR in our office. This allows us to program the computer and EHR to work in our workflow, we use the computer to show xrays, videos, explain disease etc. In the hospital this would never work as its just to clunky to get anything to show or work there. We REALLY need to stop the requirement EHR certification for MACRA and such. The objectives and measures for MU/ACI and quality are SO complicated and out of the workflow of normal practice that it completely disrupts the encounter. The cascade described is exactly the problem. Seriously, can we just stop adding more and more onerous, burdensome, expensive irrelevant activities that interfere with my ability to care for my patients? We are at a breaking point here.
That’s a good point Brian. For me it depends on how it’s done. As long as they still engage me while inputting the data, I don’t mind it. When they zone out for a minute or two doing something without communicating what they’re doing it makes the visit quite awkward.