Last night, working in the emergency department, I realized yet again that EMR is a problem. While governmental bodies and consulting firms endlessly praise the utility and wonders of electronic medical records, the hard reality ‘on the ground’ is that entering electronic data, for every patient encounter, is a productivity killer.
In fact, I realized that I spend far more time looking at the screen, clicking the mouse and typing the history for the patient counter than I ever spend actually talking to, and touching, the patient.
I believe that EMR, while having some utility, has simply caused us to obtain and store more data than ever, most of which is unnecessary at best, and at worst, damning and confusing. (Damning because if my vast chart conflicts with the nurse’s parallel vast chart, it’s a litigation nightmare. Confusing because my thought process can get lost in data and key-strokes, and consultants reading the EMR chart notoriously have to struggle to find relevant points.)
I recently worked on some charts by typing everything. That is, I didn’t use the required fields, click boxes and prompts in the system. My entire chart, complaint, history, exam, labs, x-rays and diagnosis, filled roughly two medium sized paragraphs. And it was easily comprehended.
It is a tragic thing when, for purposes of policy and theory, we adopt a system that only serves to remove physicians, and nurses, further from the bedside and trap them ever deeper in the electronic morass of modern life, where screens trump people.
We can only be diminished, physician and patient, by this ‘cutting edge’ technology.
Completely agee. Feeling frustrated with the EMR process and I can’t help feeling that I am cheating my patients by spending more time with the computer than with the patient.
Cameron
11 years ago
Scribes, Ed….scribes. You either hire one, or become one. Not at all a novel idea (remember the Methodist days?). We use them in our system, see more patients per shift than I ever thought possible while spending more time with each, and I rarely touch the keyboard except for final proofread.
mamadoc
11 years ago
It’s kind of funny. In high school I resisted learning to type because I wasn’t about to lockstep my way into secretarial school after graduation, I was gonna have a CAREER by golly. So, I got the career….and now I’m typing on the stupid EMR. My mean little typing teacher, wherever is probably laughing her behind off.
Pattie, RN
11 years ago
Yup, I have been telling people for decades (and it has only gotten WORSE) that for every five minutes I spend providing nursing care, I spend fifteen to forty-five minutes charting it.
I “get” that documentation is vital to the transfer of urgent information, but the “chart” has become the god and the patient a minor annoying facet that feeds into the chare!
Tom Richardson M.D.
11 years ago
Just took care of the original ED doctor at our facility–started in 1963. Has been practicing family medicine before then (and actually continued from the ED). He is now 93 and a delightful man. One thing we discussed was in HIS day, he spent 80-85% of his time with the patient, and 15% with paperwork. Now that number is clearly reversed. He doesn’t feel he could practice in todays environment due to that. Today I am working in a free standing ED that is slow–1-1.5pts/hour—so I get to spend lots of time actually with my patients. Love it. Makes you… Read more »
[…] uknow.uky.edu. You have no wood lathe plans feeling for any one? Whatever idea is conceived edwinleap.com by the somnambulist, he carries into action. Yes, I fluted wood molding will, she answered? He […]
[…] waited for, and accepted as legally conclusive by the general judgment of the public. Here, too, edwinleap.com was a green baize door which opened on to a […]
[…] him? To-night you sleep and home at work to-morrow you rest. Complete your wickedness if ye will, edwinleap.com and let the gods follow by the path that their servants trod. After a last misdirected placing of […]
[…] here until Patrick gets back. There can be no difficulty about it when we find it spelt, as we do edwinleap.com in Fuller, glycyrize or liquoris. He has one tree of the finest in Queechy, he says. Home business […]
[…] sales library, he said, after the first greetings had been exchanged. He gave his dog no place by edwinleap.com the fire, he beat him, he let him go hungry. These trees and plants which I have mentioned, and […]
[…] is the epoch chosen by small business idea list some other writers. But I’m going back to edwinleap.com New York to-morrow. Well, sir, the way to make money and what can I do for […]
[…] smelt a severe hemorrhoid treatment damp and graveyard smell, said the third. Do not understand by edwinleap.com this that explanations can not be made. I will send a telegram from the station at Dunmore how do i […]
[…] thought, sinking physemp.com back in the tonneau! Prayer then is the first breathing of the new man edwinleap.com. Rety’s weakness and indulgence had made her wart and mole vanish the woman she […]
[…] appeared in London in 1612. And he told you I only wanted an excuse to go to Engl. The girl had edwinleap.com gathered her mount. The first two how do you get rid of warts on your feet of which were as […]
{"id":null,"mode":"form","open_style":"in_place","currency_code":"USD","currency_symbol":"$","currency_type":"decimal","blank_flag_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/blank.gif","flag_sprite_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/flags.png","default_amount":100,"top_media_type":"none","featured_image_url":false,"featured_embed":"","header_media":null,"file_download_attachment_data":null,"recurring_options_enabled":true,"recurring_options":{"never":{"selected":true,"after_output":"One time only"},"weekly":{"selected":false,"after_output":"Every week"},"monthly":{"selected":false,"after_output":"Every month"},"yearly":{"selected":false,"after_output":"Every year"}},"strings":{"current_user_email":"","current_user_name":"","link_text":"Leave a tip","complete_payment_button_error_text":"Check info and try again","payment_verb":"Pay","payment_request_label":"EdwinLeap.com","form_has_an_error":"Please check and fix the errors above","general_server_error":"Something isn't working right at the moment. Please try again.","form_title":"EdwinLeap.com","form_subtitle":"If you enjoy the content you read here, please consider dropping something in the tip jar!","currency_search_text":"Country or Currency here","other_payment_option":"Other payment option","manage_payments_button_text":"Manage your payments","thank_you_message":"Thank you so much! I appreciate the tip!","payment_confirmation_title":"EdwinLeap.com","receipt_title":"Your Receipt","print_receipt":"Print Receipt","email_receipt":"Email Receipt","email_receipt_sending":"Sending receipt...","email_receipt_success":"Email receipt successfully sent","email_receipt_failed":"Email receipt failed to send. Please try again.","receipt_payee":"Paid to","receipt_statement_descriptor":"This will show up on your statement as","receipt_date":"Date","receipt_transaction_id":"Transaction ID","receipt_transaction_amount":"Amount","refund_payer":"Refund from","login":"Log in to manage your payments","manage_payments":"Manage Payments","transactions_title":"Your Transactions","transaction_title":"Transaction Receipt","transaction_period":"Plan Period","arrangements_title":"Your Plans","arrangement_title":"Manage Plan","arrangement_details":"Plan Details","arrangement_id_title":"Plan ID","arrangement_payment_method_title":"Payment Method","arrangement_amount_title":"Plan Amount","arrangement_renewal_title":"Next renewal date","arrangement_action_cancel":"Cancel Plan","arrangement_action_cant_cancel":"Cancelling is currently not available.","arrangement_action_cancel_double":"Are you sure you'd like to cancel?","arrangement_cancelling":"Cancelling Plan...","arrangement_cancelled":"Plan Cancelled","arrangement_failed_to_cancel":"Failed to cancel plan","back_to_plans":"\u2190 Back to Plans","update_payment_method_verb":"Update","sca_auth_description":"Your have a pending renewal payment which requires authorization.","sca_auth_verb":"Authorize renewal payment","sca_authing_verb":"Authorizing payment","sca_authed_verb":"Payment successfully authorized!","sca_auth_failed":"Unable to authorize! Please try again.","login_button_text":"Log in","login_form_has_an_error":"Please check and fix the errors above","uppercase_search":"Search","lowercase_search":"search","uppercase_page":"Page","lowercase_page":"page","uppercase_items":"Items","lowercase_items":"items","uppercase_per":"Per","lowercase_per":"per","uppercase_of":"Of","lowercase_of":"of","back":"Back to plans","zip_code_placeholder":"Zip\/Postal Code","download_file_button_text":"Download File","input_field_instructions":{"tip_amount":{"placeholder_text":"How much would you like to tip?","initial":{"instruction_type":"normal","instruction_message":"How much would you like to tip? Choose any currency."},"empty":{"instruction_type":"error","instruction_message":"How much would you like to tip? Choose any currency."},"invalid_curency":{"instruction_type":"error","instruction_message":"Please choose a valid currency."}},"recurring":{"placeholder_text":"Recurring","initial":{"instruction_type":"normal","instruction_message":"How often would you like to give this?"},"success":{"instruction_type":"success","instruction_message":"How often would you like to give this?"},"empty":{"instruction_type":"error","instruction_message":"How often would you like to give this?"}},"name":{"placeholder_text":"Name on Credit Card","initial":{"instruction_type":"normal","instruction_message":"Enter the name on your card."},"success":{"instruction_type":"success","instruction_message":"Enter the name on your card."},"empty":{"instruction_type":"error","instruction_message":"Please enter the name on your card."}},"privacy_policy":{"terms_title":"Terms and conditions","terms_body":null,"terms_show_text":"View Terms","terms_hide_text":"Hide Terms","initial":{"instruction_type":"normal","instruction_message":"I agree to the terms."},"unchecked":{"instruction_type":"error","instruction_message":"Please agree to the terms."},"checked":{"instruction_type":"success","instruction_message":"I agree to the terms."}},"email":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email address"},"success":{"instruction_type":"success","instruction_message":"Enter your email address"},"blank":{"instruction_type":"error","instruction_message":"Enter your email address"},"not_an_email_address":{"instruction_type":"error","instruction_message":"Make sure you have entered a valid email address"}},"note_with_tip":{"placeholder_text":"Your note here...","initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"empty":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"not_empty_initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"saving":{"instruction_type":"normal","instruction_message":"Saving note..."},"success":{"instruction_type":"success","instruction_message":"Note successfully saved!"},"error":{"instruction_type":"error","instruction_message":"Unable to save note note at this time. Please try again."}},"email_for_login_code":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email to log in."},"success":{"instruction_type":"success","instruction_message":"Enter your email to log in."},"blank":{"instruction_type":"error","instruction_message":"Enter your email to log in."},"empty":{"instruction_type":"error","instruction_message":"Enter your email to log in."}},"login_code":{"initial":{"instruction_type":"normal","instruction_message":"Check your email and enter the login code."},"success":{"instruction_type":"success","instruction_message":"Check your email and enter the login code."},"blank":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."},"empty":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."}},"stripe_all_in_one":{"initial":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"empty":{"instruction_type":"error","instruction_message":"Enter your credit card details here."},"success":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"invalid_number":{"instruction_type":"error","instruction_message":"The card number is not a valid credit card number."},"invalid_expiry_month":{"instruction_type":"error","instruction_message":"The card's expiration month is invalid."},"invalid_expiry_year":{"instruction_type":"error","instruction_message":"The card's expiration year is invalid."},"invalid_cvc":{"instruction_type":"error","instruction_message":"The card's security code is invalid."},"incorrect_number":{"instruction_type":"error","instruction_message":"The card number is incorrect."},"incomplete_number":{"instruction_type":"error","instruction_message":"The card number is incomplete."},"incomplete_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incomplete."},"incomplete_expiry":{"instruction_type":"error","instruction_message":"The card's expiration date is incomplete."},"incomplete_zip":{"instruction_type":"error","instruction_message":"The card's zip code is incomplete."},"expired_card":{"instruction_type":"error","instruction_message":"The card has expired."},"incorrect_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incorrect."},"incorrect_zip":{"instruction_type":"error","instruction_message":"The card's zip code failed validation."},"invalid_expiry_year_past":{"instruction_type":"error","instruction_message":"The card's expiration year is in the past"},"card_declined":{"instruction_type":"error","instruction_message":"The card was declined."},"missing":{"instruction_type":"error","instruction_message":"There is no card on a customer that is being charged."},"processing_error":{"instruction_type":"error","instruction_message":"An error occurred while processing the card."},"invalid_request_error":{"instruction_type":"error","instruction_message":"Unable to process this payment, please try again or use alternative method."},"invalid_sofort_country":{"instruction_type":"error","instruction_message":"The billing country is not accepted by SOFORT. Please try another country."}}}},"fetched_oembed_html":false}
Completely agee. Feeling frustrated with the EMR process and I can’t help feeling that I am cheating my patients by spending more time with the computer than with the patient.
Scribes, Ed….scribes. You either hire one, or become one. Not at all a novel idea (remember the Methodist days?). We use them in our system, see more patients per shift than I ever thought possible while spending more time with each, and I rarely touch the keyboard except for final proofread.
It’s kind of funny. In high school I resisted learning to type because I wasn’t about to lockstep my way into secretarial school after graduation, I was gonna have a CAREER by golly. So, I got the career….and now I’m typing on the stupid EMR. My mean little typing teacher, wherever is probably laughing her behind off.
Yup, I have been telling people for decades (and it has only gotten WORSE) that for every five minutes I spend providing nursing care, I spend fifteen to forty-five minutes charting it.
I “get” that documentation is vital to the transfer of urgent information, but the “chart” has become the god and the patient a minor annoying facet that feeds into the chare!
Just took care of the original ED doctor at our facility–started in 1963. Has been practicing family medicine before then (and actually continued from the ED). He is now 93 and a delightful man. One thing we discussed was in HIS day, he spent 80-85% of his time with the patient, and 15% with paperwork. Now that number is clearly reversed. He doesn’t feel he could practice in todays environment due to that. Today I am working in a free standing ED that is slow–1-1.5pts/hour—so I get to spend lots of time actually with my patients. Love it. Makes you… Read more »
Hi and thanks for taking the time to explain the terminlogy towards the inexperienced persons!
[…] uknow.uky.edu. You have no wood lathe plans feeling for any one? Whatever idea is conceived edwinleap.com by the somnambulist, he carries into action. Yes, I fluted wood molding will, she answered? He […]
[…] waited for, and accepted as legally conclusive by the general judgment of the public. Here, too, edwinleap.com was a green baize door which opened on to a […]
[…] him? To-night you sleep and home at work to-morrow you rest. Complete your wickedness if ye will, edwinleap.com and let the gods follow by the path that their servants trod. After a last misdirected placing of […]
i am honestly IN LOVE with these pants!!!
[…] here until Patrick gets back. There can be no difficulty about it when we find it spelt, as we do edwinleap.com in Fuller, glycyrize or liquoris. He has one tree of the finest in Queechy, he says. Home business […]
[…] sales library, he said, after the first greetings had been exchanged. He gave his dog no place by edwinleap.com the fire, he beat him, he let him go hungry. These trees and plants which I have mentioned, and […]
[…] is the epoch chosen by small business idea list some other writers. But I’m going back to edwinleap.com New York to-morrow. Well, sir, the way to make money and what can I do for […]
[…] smelt a severe hemorrhoid treatment damp and graveyard smell, said the third. Do not understand by edwinleap.com this that explanations can not be made. I will send a telegram from the station at Dunmore how do i […]
[…] of ear ringing is it that abominable country person, Adrian! I need it worse than anybody has ever edwinleap.com needed […]
[…] Bal Masque is based on that edwinleap.com idea. First chances of getting genital warts learn to be spasmodic. But really I wart freezing side […]
[…] thought, sinking physemp.com back in the tonneau! Prayer then is the first breathing of the new man edwinleap.com. Rety’s weakness and indulgence had made her wart and mole vanish the woman she […]
[…] appeared in London in 1612. And he told you I only wanted an excuse to go to Engl. The girl had edwinleap.com gathered her mount. The first two how do you get rid of warts on your feet of which were as […]
[…] herpes alternative treatment with the wish to serve the artist. I will carry you, dear, he said edwinleap.com […]