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On March 5, a certain physician at a major East Coast hospital (that's all he's willing to reveal about his identity) tweeted:
It was a medical insider joke, touching a widespread pain point: that current electronic medical records systems tend to suck up so much of the doctor's attention that interaction with the patient suffers.
The account's name referred to the electronic health records company Epic, and subsequent tweets purported — in a clearly satirical way — to be in the diabolical voice of the software's masters.
The account description included the ominous "I will not rest until doctors do nothing but click buttons. Eye contact is evil." And its tweets extolled the joys of writing up elaborate notes on patients — charting — and endless inbox clutter, and clicking, clicking, clicking.
Electronic medical records — from a variety of vendors, not just Epic — are the bane of many doctors' existence. Amid its jokes, the parody site also shared serious, real-life findings that dealing with electronic records takes up about half of a primary care doctor's day, and that a 10-hour shift in an emergency department can require up to 4,000 clicks.
And it scoffed at doctors for complaining:
In its first day or so, the account garnered more than 1,500 followers. Now, after less than a month, it's up to more than 10,000, has been written up in Inside Digital Health and been featured on the medical podcast "Explore the Space."
The Epic account can't compete with some other parody accounts — the 5-million-follower-strong @TheTweetOfGod, or the 600,000-plus followers of Devin Nunes' Cow — but for thousands of doctors who have few other outlets for their frustrations, it offers the balm of a good laugh, fans said.
Dr. David Scales, an assistant professor of medicine at Weill Cornell Medical College with a doctorate in sociology, said the parody reminds him of "[Jon] Stewart, Trevor Noah or John Oliver in that sometimes just saying the truth can be satire."
Systems like Epic's have captured market share because they're good at "capturing revenue" — billing for medical services, he wrote in an email. "But they have also captured increasing amounts of physician time and attention at the expense of patients. The account captures these sentiments in humorous and simple ways that resonate in the absurdity that all folks working through EMRs wrestle with daily."
Dr. Elisabeth Poorman, a primary care physician in Seattle who also follows the account, emailed:
"I think we feel really frustrated that the majority of our time is spent on these systems where we have no control as providers, and sometimes even as clinics. When there is an 'update' and the user interface is redesigned, we are rarely asked how it will impact patient care or what features we want to keep or change."
Asked whether Epic had any response or reaction to the parody account, a company spokeswoman responded: "We do not."
The account's creator said in a phone interview that he had no inkling it would explode as it has. He was in the midst of wrestling with the records system to order up a complex treatment, a process that took 10 minutes even with plenty of expertise, and he started the account "just to make myself laugh — and vent."
He showed it to a couple of people he works with, and by the end of that week, the account was up to 5,000 followers.
Some might object that doctors have little to really complain about, he said — "I'm not out there digging ditches all day in the hot sun." But problematic medical records systems "really take away from our time with patients," and he said he went years without a full day off from Epic-related work.
Many of the issues that the account raises have also been raised in serious settings. The book "Cognitive Errors and Diagnostic Mistakes" includes descriptions of errors caused by electronic medical records, and notes: "The EMR error occurs when clinicians are forced to mindlessly click buttons on a computer to give the appearance of taking care of their patients at the expense of actually taking care of their patients."
Or as the Twitter account puts it:
Asked what he thinks the Twitter account can accomplish, the author answered bluntly: "Nothing."
"It's just an outlet," he added. " I started this because I couldn't change Epic. I would go to our people and say, 'Listen, to order a basic lab I have to click 10 times. Can anything be done to simplify it?' And it would constantly be, 'You know, here's how you adjust to us,' rather than saying, 'You're right, you shouldn't have to do that. Let's fix it.' "
He expects the account's following to stop growing soon, figuring that most Twitter users who would appreciate it have already found it. If it does flag, he's already gotten great gratification from appreciative messages, he said. And "It's helping me know that I'm not alone."
Definitely not alone. Another major electronic health record vendor, Cerner, has already inspired a parallel account: CernerParodyEHR.
This article was originally published on March 29, 2019.
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- Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records
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