Monday, August 13, 2007
The electronic medical record and you
Steve Huff
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- Tired, old elephant dressed in lipstick and heels
- Time to reshuffle the deck
- Knowing where to draw the line
From the RoundTable blog
An infestation marches through your doctor's office like an army of chattering ants. It breeds in the windowless offices of the accountants and insurance clerks. Then it swarms the front desk. Now it's in the exam rooms -- between you and your doctor. It is the electronic medical record, or EMR.
There's no stopping it; computers are the way of the future. One in four medical offices uses them extensively. The government offers incentives for EMR and pushes them hard.
For years I've dreaded medical print-outs from Carilion or the Department of Veterans Affairs: They contain about a sentence of useful information for every five pages of drivel. Now I find myself a passenger on the same electronic bandwagon.
At first it seems like a great idea: Gone are the days of shaking down the entire office for a lost chart; prescriptions reach the pharmacy before the patient reaches the check-out window; roomfuls of records vanish in a puff in cyber-smoke; paper cuts are a thing of the past.
Then come the not-so-welcome consequences. Have you had a harder time getting appointments? Does your doctor pay more attention to his computer than to you? Was he already an hour behind? Do you worry about those stolen hard drives in the news? In the exam room, when my fingers stop flying and the awkward silence breaks, what I end up with, if I'm not careful, is an impatient patient and a massive manuscript of mangled phrases, stray symptoms, misspelled words and irrelevant, if not misleading, information.
So far the patients have been more than gracious. They liken their visits, politely, to having a conversation with someone whose cellphone keeps ringing or who pulls out his Blackberry every 30 seconds to check his e-mail.
It takes a toll on the doctors, too. The other day in the office a colleague rounded the corner, tears streaming down her face. "I can't stand this anymore," she said. "I'm getting mad at my patients because they're telling me what's wrong with them and I can't find the right box to click."
As I was taught, the medical note should record what goes on at each visit. Together, those visits form the foundation of your medical care. They remind us what we need to address at the next visit. They keep us from asking redundant questions, ordering duplicate tests or repeating mistakes. What could be more important than that?
Several things, apparently. One is billing. For years doctors have guessed at what to charge, rather than executing an insurance algorithm that would baffle Einstein. To avoid getting into trouble, we simply undercharge. With EMR it's simple: Click more boxes, charge more money. (I don't use this function, but its framework dominates the system.)
EMR also protects us from lawsuits. By including every last piece of information -- relevant or not -- it's hard to assert that a doctor was ignorant of the facts.
Finally, EMR caters to oversight agencies, who require us to keep track of how many patients get tetanus boosters, use smoke detectors and so on.
All that information is important, but has little to do with the poison oak for which you made your appointment or the insomnia and depression that were uncovered. There it all floats, though, in a bowl of alphabet soup.
Fortunately, we're getting better at EMR, one day at a time. We've also found that EMR works wonders for sending messages within the office (no more sticky pads!), writing prescriptions, making appointments and so on. Search functions are handy: Within days of hearing about problems with Vioxx and Avandia, I sent letters to patients who took them.
I foresee a day when the VA will communicate with Carilion, and both will communicate with me. If I get sick in Japan, a doctor there will pull up my records from Virginia. He'll dictate a note in Japanese, which will appear at my office in English. By the time I get home, I'll have prescriptions and appointments already made.
Until then, if your doctor gives you a blank look, prompt him well. He may be oblivious to the information right under his nose.
Huff, a family physician from Patrick County, is a Roanoke Times columnist.
