Monday, August 19, 2013

EMR's : Good or Bad

Over on GregSmithMD, Dr. Smith talks about the downside of Electronic Medical Records: Thing one: they distract the doctor, Thing Two: They take a lot of time and decrease free/casual/down/recharging time for docs, Thing Three: Some older wiser therapists opted out and retired, taking their talents and the institutional memory with them.  Dr. Smith also points out that it helps to have legible notes.

As I've mentioned, I left my job at the clinic where I've worked one morning a week for the past 15 years because I couldn't deal with learning the new EMR, see My Epic Meltdown

So never mind the fact that EMR's require that doctors collect all sorts of information with each visit which may or may not be relevant to the patient's care.  Treatment becomes a checkbox from a drop down list.  The screen sucks time and attention.  But I have a different concern.  When I go to a doctor, I ask for a copy of the consultation note.  I keep copies of my labs, copies of notes from any specialist I see, results of any test I have.  I've been struck by how these notes contain gross examples of inaccurate information.  So far, nothing I've seen has been scary, but there's the documentation that my liver and spleen are normal in size by the doctor who didn't check (maybe X-Ray vision was involved).  And I really like how I'm "currently married."  Does that imply that it's a temporary state?  I've been with the same guy since I was 18, at this point I'm thinking it may last for a bit. Okay, I'm nitpicking. None of this matters, and I avoid docs with electronic records, so mistakes hopefully don't get transmitted.

Here's my question about Electronic Records:
~ Don't they risk that misinformation will be perpetuated?  Isn't this dangerous?  Shouldn't patients review the records to be sure they are correct?  Why aren't we more worried about this?
~Don't they increase the physician liability?  If a doctor writes something in the record, even a note from a phone call, and this contains important information, and these charts quickly get full of information because every phone call, every visit with every healthcare professional (including phone calls requesting refills taken by a nurse) is a separate note, isn't each physician responsible for knowing what's in all these now-legible notes, and if something gets buried in one of many notes and the physician misses something important, isn't it now an issue?  Patient calls and notes they developed a rash with a medicine.  Doctor puts it in a phone note, but doesn't record it in the allergy section and forgets at the next visit.  Patient later has a bad reaction when given that same medication a few years later.  

Okay, so what have your experiences been to date with EMRs?  Good, bad, happy, sad?