Effectively, it lastly occurred.
I turned an MD 30 years in the past, lengthy earlier than the EMR existed. This was additionally properly earlier than Dr. Google appeared on the scene. A time when medical data existed solely on paper.
I bear in mind getting annoyed after I needed to see a affected person with out their paper chart, because it was nonetheless in one other doctor’s workplace. I used to be griped about not with the ability to discover a explicit piece of knowledge, equivalent to a lab report or session be aware, when all I had in my fingers was quantity 1, not quantity 5.
I additionally recall the period when not everybody dictated their notes. Too typically, I used to be frantically attempting to decipher another person’s handwriting earlier than strolling into my examination room to debate vital info with a affected person.
I actually don’t miss writing out all prescriptions by hand – particularly for my sufferers who had 40 prescriptions and wished two units (one for a one-month provide at their native pharmacy and one for a yearly provide to ship to their mail order pharmacy).
I used to be “on the crew” when our giant clinic first heralded EPIC, and I used to be an “at-the-elbow tremendous person” serving to my colleagues once they had been studying how one can navigate the brand new expertise.
The preliminary imaginative and prescient for the EMR was good: have one place for all to speak, doc, and share affected person care. It was a aid to have a medicine checklist, an issue checklist, and take a look at outcomes. It was nice to share, talk, and collaborate with colleagues.
Quick ahead to our present period.
The EMR is now an epic failure – pun supposed!
Downside lists are sometimes incorrect, typically out of date, and principally only a coding software for insurance coverage reimbursement.
Medicine lists are by no means present or fully correct. Sure, by no means. Belief me, I do know.
Communication is usually degraded to templated notes that say nothing actually, aside from a number of traces of poor grammar that one has to first scroll by 10 pages simply to seek out. Translate: one web page paper notes at the moment are 14-page digital notes.
Rubbish in, rubbish out. I might go on and on.
However, essentially the most surprising half is that the EMR is now really dangerous.
Like different human beings, physicians are sufferers too. And generally, we’ve got advanced medical considerations or a persistent sickness that doesn’t match neatly into one medical self-discipline.
We want care like everybody else for easy issues equivalent to a laceration, an ankle sprain, bronchitis, and so forth. We additionally get handled for most cancers, ache, autoimmune illnesses, and so many different issues that each one sufferers can get.
What does this need to do with the EMR?
Effectively, think about that you just had been referred to a specialist, and that there have been already two different referrals within the system for a similar specialty. It could seem that you just had been “physician buying” (an insulting time period) while you really had no concept that triplicate digital referrals existed.
This explicit specialty covers many alternative medical situations, each acute and persistent. I’ve seen three completely different physicians on this specialty for particular medical situations – a grand whole of 4 workplace visits in 15 years – and was referred by my main care doctor every time.
Final month, I used to be confused by a quick and moderately brisk voicemail on my cellphone concerning a specialty referral. The employees member said, “please name our workplace as there are some points concerning your referral.”
I used to be caring for sufferers, so I didn’t get this message till after workplace hours. I logged into the EMR affected person portal to see if I might glean any info.
I used to be shocked to see a prolonged, detailed be aware from this specialist whom I’ve by no means met.
In my file.
It was a be aware to her medical employees member concerning if I may very well be seen for a session in response to the digital referrals.
The content material of this specialty doctor’s be aware was dangerous – and that’s me being well mannered! It had quite a few inaccurate statements about me and about my cause for potential session.
The doctor had messaged her employees to set boundaries and situations (six, to be exact), and he or she used capital letters for emphasis. If these situations had been met, then – and solely then – would she see me for session.
However just for one go to.
Did this doctor spend an hour in my EMR wanting by paperwork? She should have had loads of time on her fingers as a result of her be aware to her employees member was fairly lengthy.
And completely false.
Now, for all to see, anybody who appears at my digital file can learn her be aware. A be aware written by a doctor I’ve by no means met. Somebody who is aware of nothing about me. But, she has “documented” dangerous and incorrect assumptions about me.
I’m nonetheless processing my anger.
My head continues to be reeling.
It took me a full week to regain my composure.
My main care doctor apologized at least ten instances, though this had nothing to do together with her. She fully agreed that this specialist’s documented be aware was callus, dismissive, uncaring, dangerous, and insulting.
I’m not “physician buying” and by no means have been.
I’m not difficult, however I’ve advanced medical considerations (as do 80 p.c of my sufferers).
There actually isn’t any nice analogy to this example, however the closest one I can consider is being thought-about responsible till confirmed harmless.
To cite my PCP, “You deserve a care crew that’s engaged with compassionate curiosity and really listens.”
Don’t all of us?
Maybe the one good that has come from this expertise is that I’m a good higher advocate for my very own sufferers and shoppers, and a stronger ally to my colleagues.
I all the time have been and all the time shall be.
Susan J. Baumgaertel is an inner medication doctor.