The EMR-SUM gain or loss?

[jmj11]

Looking at the EMR at this point in history, considering new providers to a system having to learn its idiosyncrasies, older providers who are not electronic media savoy, patients using their portal to that system, do you think it is a sum gain for the reduction of death and increasing the quality of the life of patients, and increasing of quality of life of the providers and their staff?

There's a background to his honest question that I will share if this question goes anywhere.

[rev ronin]

Net loss. There's probably a net gain for substitute endpoints, but I have yet to see anything showing a drop in all cause mortality. Partially because without an EMR, it's simply too hard to track that.

[EMEDPA]

I can see the advantages of the system in terms of legibility of records and being able to view them anywhere. I don't see any advantage of EMRs over professionally transcribed dictations, however. I am sure EMRs have killed at least as many people as they have helped, if only through clicking the wrong order box for mg/kg rather than mg( a well known recent national case had a nurse overdose someone on bactrim DS because the physician clicked mg/kg instead of mg and they developed stevens johnson syndrome and died after taking some ridiculously high dose like 20 tabs bid for a few days). Productivity is still about 1/2 what it was in the pre-emr days. Most places I work had to double staff when they went to an EMR to see the same # of patients and that never improved. EMRs are about better billing, not better patient care. I have no problem with patients seeing their lab test results and xrays, etc online, however the trend of allowing pts routine 100% access to their own charts results in many problems. Patients call and argue with you about what happened. They deny direct quotes in the notes. They say " why did I get this test when I just wanted that test?", etc We can't be as honest in our notes when we know the patient will read them and come back and yell at us. We can say "pt has strong odor of alcohol on breath and noted to have stumbling gait" and they call and yell at us. We get hate mail and they complain to the CEO of our hospitals and get notes from them asking us to amend the charts. And some EMRs are user friendly while others are not. No one can agree on a standard EMR so I have to use 5 different ones between my different practice settings. Over the years I have had far more frustrations over EMRs than over almost any other aspect of my practice.  EMRs also encourage fraud in charting. Most have a button that says " all other systems reviewed and negative" and we are encouraged to use it (I don't) to increase billing a higher level of service. Really, you asked a 14 year old with an ankle sprain about penile discharge, hemoptysis, paroxysmal nocturnal dyspnea, and rectal bleeding? Sure you did. 

[iconic]

At least I am glad my billing is based on time not complexity of charting 

[rev ronin]

3 hours ago, iconic said:

At least I am glad my billing is based on time not complexity of charting 

That has been a great change.  I don't write boilerplate BS in my occ med charts any more.  Well, that's not entirely true, I do summarize original accident, previous interventions, and recent developments, only changing it occasionally, but that's for ME not because some weird rule required me to do something I didn't need to.  I do ROS'es and PFSHx when it matters, rarely take vitals, and spend the visit on caring for the patient and solving their current occ med problem.

[ventana]

Huge net loss for pcp fields. 
 

I now use dragon and a templates PE which I change with every patient. 

[jmj11]

I  also have mixed feelings. I created my own EMR when I owned my practice (based on Microsoft excel and word)  but then purchased the only EMR that uses that same format.  I did have toggles for every answer. But, I had to type while in the room with the patient, which I hated. But otherwise I couldn't keep up and still supply the data points that some insurances required.

As a patient now, I can say that if had not been a PA, I would be dead now. Many times my local oncologists has sent in the wrong tests, the wrong chemo orders, and etc. Not that he doesn't know what he's doing, but he makes mistakes in the EMR. His predecessor here did the same, or even worse. They both explain that the EMR is very confusing when I point out they sent in the wrong orders. I know as I worked for the same hospital and had trained on it before medical retirement. Every time I go to the lab I have to examine the tubes and tell them exactly what tests I need as they cannot understand the orders. If I were just a normal patient, this would be really screwed up.

I see this local oncologist out of convenience but my real oncologist is a sub-specialist in Seattle. So far, she has not made any mistakes on her Epic orders.

 

 

[Mayamom]

3 hours ago, jmj11 said:

Many times my local oncologists has sent in the wrong tests, the wrong chemo orders, and etc. Not that he doesn't know what he's doing, but he makes mistakes in the EMR. His predecessor here did the same, or even

OMG.   I am so sorry to read this.   Medicine is such a broken system.   I used to be seen at a pain clinic.  Every time I went they could never keep my medications straight.  I'm guessing because the wrong box was checked. 

[Apollo1]

Following on @EMEDPA post, I politely refuse patient or administrative requests to amend charts. Standard reply is "that's what I observed during my evaluation and treatment;" actual answer should be "you're not qualified to comment on ..."

There should be an internal wall between clinicians and administration (similar to the wall between editorial and advertising). I don't envy their responsibilities; however, their overall pushing of profits over patient care (regardless of what they say) is a root cause of our system's dysfunction.

Edited May 6, 2022 by Apollo1

[rev ronin]

1 hour ago, Apollo1 said:

 actual answer should be "you're not qualified to comment on ..."

Or even a complaint to the medical board for an attempt to practice medicine, by proxy, without a license.

[ventana]

12 hours ago, rev ronin said:

Or even a complaint to the medical board for an attempt to practice medicine, by proxy, without a license.

I think this is a resource we need to follow - repeatedly

against insurance companies, against admin, against company policies that hurt patient care.......

[iconic]

16 hours ago, rev ronin said:

Or even a complaint to the medical board for an attempt to practice medicine, by proxy, without a license.

Except that what’s the medical board gonna do - revoke their nonexistent license?

[rev ronin]

1 hour ago, iconic said:

Except that what’s the medical board gonna do - revoke their nonexistent license?

A consent decree and fine, which is big 'ol slap on the wrist.  Mind you, I haven't seen it done, but it's within their purview.  Washington routinely fines unlicensed massage practitioners--not for prostitution per se, but for the unlicensed practice of a licensed profession.

[Cideous]

Clinical loss

Billing gain