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.


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