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It happens every day, in exam rooms across the country, something that would have been unthinkable 20 years ago: Doctors and nurses turn away from their patients and focus their attention elsewhere — on their computer screens.
By the time the doctor can finally turn back to her patient, she will have spent close to half of the appointment serving not the needs of her patient, but of the electronic medical record.
Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information.
Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.
To fix them, hospital administrators and clinicians need to work together to demand better products from EMR manufacturers and to urge government to relax several provisions of the HITECH Act, the 2009 law that spawned many of the problems with EMRs.
How did technology that has increased efficiency in every other industry become such a drag on health care? For starters, people who take care of patients did not design or choose these systems. They were foisted upon us.
Doctors and nurses know that good diagnosis and treatment requires listening attentively to their patients. They spend years learning to parse the clues that patients offer, both the physiological and personal, in order to provide the right care.
The sound of medicine is not the click of a mouse. It is the human voice. Let’s bring it back.
To do this well takes time and undivided attention.
Making sense of a patient’s blood panel means knowing the patient’s work and eating habits, and where he or she may have traveled. We need to know if the patient is experiencing a traumatic life event, like the death of a parent or domestic abuse, in order to interpret an elevated blood pressure.
Instead of making this easier, most EMRs create extra work. A lot of extra work, thanks to endless prompts with multiple choice answers that hardly ever fit the facts and that demand click after click to get anything done.
Want to order a simple test? That requires getting through multiple prompts. Need to write a prescription -- an exercise that used to take less than 15 seconds? Another set of clicks.
Typing, filing, mailing results and placing referrals all used to be done by assistants. Now, EMRs put that burden on clinicians, and we must do it during office visits, or “encounters,” as EMRs call them. And when the wrong button is clicked, the wrong test or drug is ordered, or it does not go through at all, delaying medical care.
It’s death by a thousand clicks, and it happens every day.
We are frustrated by EMRs because they pull us away from our patients. We are driven mad by the fact that EMRs in different locations do not talk to each other. And we think it’s just wrong that much of the EMR’s busywork is about optimizing billing for the hospital.
Who is to blame? Start with EMR manufacturers, who lobbied Congress to require every hospital and doctor’s office to install an EMR system; hospital administrators who bought technology that conveniently pushed billing duties onto doctors and nurses; and federal regulators, who imposed on EMRs numerous quality metric requirements that do nothing to improve care.
We do not want to go backward. We believe that computing is essential to the future of medicine. We simply want all EMRs to live up to their promise of improving care and making patient information readily available.
Thousands of doctors in Boston and across the country are expressing the same frustration, through gritted teeth, between exasperated sighs, and in resignation letters. EMRs are driving too many health care providers to hang up their scrubs and white coats in search of work that is less infuriating and more fulfilling.
As we continue to debate how our country will finance an equitable health care system for all, we need a long-term strategy to address this crisis in health care delivery.
The public and private institutions of this city have long and illustrious histories of leadership in health care. Now is the time to embrace that tradition and do something about EMRs. We plan to hold town hall meetings to give providers, patients and community members a chance to discuss how to address the problems of EMRs. We invite executives and administrators from all our hospital systems to participate.
The sound of medicine is not the click of a mouse. It is the human voice. Let’s bring it back, for the sake of our patients’ health and our own sanity.
John Levinson, MD, PhD, is a cardiologist and internist at Massachusetts General Hospital, where he served as vice president of IT for MGH physicians from 1994-2004.
Bruce H. Price, MD, is chief of the Department of Neurology at McLean Hospital, associate neurologist at Massachusetts General Hospital and associate professor of neurology at Harvard Medical School.
Vikas Saini, MD, is a cardiologist, the president of the Lown Institute and co-chair of the Right Care Alliance, a clinician and patient led health care reform movement.
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