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Click, click: the sound of modern medicine

This is my March EM News column.

We live in the age of EMR. An age in which it’s almost impossible to work in a hospital or clinic setting without the endless tap of keys as the metronomic background to the care we provide. But it’s almost as difficult to explain to those outside of clinical practice just how distracting it can be to do so. Because the fusion of medical practice with data entry is not yet natural. Click.

Move cursor. New paragraph. There are many reasons that this is difficult. First, physicians today may be the most highly compensated data-entry personnel in the world. High level businessmen have secretaries. Politicians have aids. Attorneys have paralegals. We have…ourselves. Or, if we are lucky, scribes. But assuming no scribes, we have our voices, our fingers and time to fill out the precious chart. Click. Move cursor. Fatal error! System will shut down.

Reboot. Wait. Wait.

New field. We have a pretty good EMR. We have learned to make it work for our practice. However, even the best requires, click, too many, click, required fields. Where once the emergency department was a place of near constant movement to and from drug cabinets and patient care rooms, it is now punctuated by click the constant presence of nurses and physicians click standing at keyboards, sitting at keyboards, click entering passwords and filling in charts that could have been much shorter.

Move cursor. Click. New paragraph. I have seen the difference. Granted, my hand-written charts in residency were abysmal by comparison. However, on those occasions when I missed charts and the computerized data system locked me out, I have done them by free-text, entering paragraphs by simply writing. Click. Writing is something I can do. In the end, my full chart was about one long paragraph in length, including chief complaint, history, review of systems, physical exam, lab and x-ray data and medical decision making. I didn’t have to click on ‘I agree with the nurse’s notes,’ or click ‘I reviewed the following data,’ click, or I reviewed each of the following labs.’ Click, click. My chart was concise, told the relevant story and was to the point.

Move cursor. Click, new paragraph. Of course, we physicians have to deal with this, but nurses have to face it in, click, perhaps greater depth. Every intervention, every walk into the room, every blood pressure, every cup of ice, click, click, documented, click, to ensure click that the patient was click appropriately click assessed for pain scale, click, safety, click, dietary measures, click, history of click, abuse, click. Their clicking goes on and on, as they spend less and less time at the bedside. Just, click, like physicians.

Move cursor. New paragraph. How much time do we have to spend with charting now? Speaking with physicians from around the country, and noting the tremendous growth of scribe programs, I know for a fact that click, EMR, click, is killing, click, patient flow, click and productivity. Click, click. From family physician offices to emergency departments, doctors spend too much time clicking, and too much time after shifts filling out chart templates. This is especially onerous in our specialty, where so many of the clicks that we click lead to no clinking money.

Move cursor. New paragraph. Previous data reviewed. I agree with myself. All of this data. All of this vast sea of data. Oceans of keystrokes, tsunamis of required fields to satisfy the great storm of government and administration and regulatory bodies. Great destructive breakers of information, mostly irrelevant, mostly extraneous, much adding only cost to care in the price of data capture, storage and IT costs. And what does it do? It provides a rich fishing ground for attorneys, who can, click, see every second of our care, click, assess every discrepancy between physician click assessment and required nursing click assessment. Click. Attorneys can only look at this and lick their lips at the lavish gift we give them with every click.

Move cursor. New paragraph. Furthermore, in an age of concerns over distracted driving, we find ourselves having to be click more concerned click with charting than click patients. In the press of busy emergency departments, as nurses ask questions and patients ask us for cups of ice, click; as phone calls come in and we view our own x-rays, click, as thoughts are interrupted by click critical labs and crashing patients click, as we try to sort through complex presentations and impossible dispositions, how are we supposed to click produce a cogent chart filled with all the required data?

Move cursor. New paragraph. I understand click the value. EMR allows us to have prompts for better charting click. It reminds us about allergies click. It produces a cleaner chart click, even if the chart is an almost cryptic seven pages of click click click fields for a pharyngitis. But click, surely we can click find a better way! We could click, require less. We could work with regulatory bodies to ask click for less instead of more click, even as they say click ‘everyone is doing it this way and besides they say you have to and it’s required!’ Click.

At the end of the click day, my fingers are tired. My eyes click tired from moving click from field to click field, up and down, often in the same click pattern over and over.

All I can say is click this. As my patients say, ‘something has got to be done.’ Click. We’re drowning in data. Crushed by clicks. Smothered by unnecessary fields. Slogged down and bogged down by acting as secretaries instead of physicians. We can do better. Click. We have to do better. Click. We need a peaceful revolution click. And deliverance from the click.

System failure. Data entry shut-down. Reboot. Tomorrow. Good click night..

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Edwin

1 Comments

Kelly

2012-03-02 21:31:48 Reply

Edwin,
Boy did this hit home for me. The practice I work for spends so much time explaining to patients why they have to fill out questionnaires that the front office staff enters into the system just so the patient can be called back for a visit…that we can hardly keep up. Add to that the fact that now the patients insurance information is no longer in the EPM section (financial) but the EHR (clinical)section. Which means the front office has to keep flipping over to the patients chart and then back to their financial chart when the patient checks out and inquires about the cost of additional tests, etc. that may have been ordered by the doctor. Templates are not the answer to streamlining paperwork or patient care. There has to be a better way.

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