Mary McAteer MD FAAP
General Pediatrician
President Indianapolis Medical Society
Indianapolis, IN
One of the biggest failures in health care is the use of the electronic medical record. By proving to be inefficient and unreliable, EMR systems have undermined confidence in the patient/physician relationship. The quality of the relationship is essential to improving our patients’ health outcomes and the health of our profession. Building that relationship involves developing trust by personally committing to creating respectful communication and defining mutual expectations.
Workflows involving EMR distract doctors from practicing the complicated skills involved in treating patients. Using EMR requires doctors to validate, navigate and input data in the system, rather than give personal attention to their patients. This has resulted in dissatisfaction for all involved in the patient experience, a known factor leading to physician burnout. Patients are given the impression that the doctor is not communicating meaningfully with them, which disengages patients from being open, decreases compliance and worsens health outcomes. Patients come with expectations that their health information is valid and complete, like their experiences conducting searches for themselves. Physicians also expect the information to be valid. But with the inefficiencies of data entry and retrieval, that reliance on validity is up for grabs.
I believe our patients trust us to bring it all together for them, and I hope they realize how much we all would like that too. To illustrate the cooperation needed, here is my story about Chris, who came to my office for his wellness visit prior to college. We are in the exam room laughing about the last time he received shots and passed out in his dad’s arms. He swallows hard when he asks about shots he may need this visit, believing that they are necessary and good. I turn to the electronic version of our 18-year relationship, which had previously existed on paper. I am searching his data, still searching, his laughter is getting a little more anxious. I am getting a bit more anxious too, trying to talk about the Colts' upcoming season or something….anything else.
Soon, Chris offers his help. He has rebuilt computers, has programming experience and feels confident with anything electronic. Appreciatively, I show him his EMR and the vast array of possible spaces where his records of past immunizations may reside. He studies the screen and we navigate through some of the options. After a while, he stands up and shrugs saying, “This is a mess. I feel sorry for you, so go ahead and give me any of the shots you think I might need.” My office staff interrupts us with a knock on the door, supplying the old paper records. Upon consulting those, he receives the appropriate vaccinations. The tragedy of this story is the waste of time, precious time, that we could have spent preparing him for this new phase of his life.
I have heard many defenses of the EMR as a necessary evolution in health care. Using an unreliable and inefficient tool will never evolve into better health care. It is imperative to develop better technologic tools to result in more productive and reliable communication, reasonable expectations, and personal commitment to patient care. We need improvements focusing on more efficient workflows and communication that uses valid clinical information. The standard for adopting clinical tools should be primarily to improve the quality of the patient experience, leading to rewarding, trusting relationships with physicians. With tools designed with the goal of serving the patient/physician relationship we will rejuvenate health care.
