David Chan , MD from UCLA, Stanford Oncology Fellowship
Updated Jun 17, 2014  · Upvoted by Kate Simmons , myofascial pain specialist and Anand Gnanaraj , Interventional Cardiologist, Apollo Specialty Hospitals, Vanagaram, Chennai. · Author has 2.2k answers and 9.9m answer views
My medical group and colleagues are totally dissatisfied with EMR. And we’ve purchased one of the most expensive programs available. Prior to purchasing it and subsequently, my group has spoken to several hundred physicians and none of them were/are happy with their systems.
The biggest complaint by far is that EMR significantly cuts back on physician productivity. In my group, the data entry, ordering process and review of labs and scans has added 90-120 minutes to each working day. Every other physician has similar complaints and has either cut back on patients or increased work hours.
Here are the common complaints:
- Data entry. This is beyond tedious. Instead of dictating “50-year-old woman with stage 2 breast cancer, T1c N1 with 2 positive nodes, ER/PR positive and HER 2-negative.” which takes about 10-15 seconds, you get to click on each item individually and wait for the computer to load and then move you to the next field. First click breast cancer, primary. Wait. Then click type like invasive ductal. Wait. Then click grade like grade 2. Wait. Then click stage, first T stage and wait, then N stage and wait, then M stage and wait. Then go individually to each biomarker parameter, first ER, then PR, then Her 2 then Ki-67. Each click takes time for the data to load and move to the next field. This is beyond stupid and a waste of time.
- Ordering prescription through E-prescribe. We previously used stamps for drugs, doses and directions on a prescription pad. You could literally stamp 6 medications on 2 prescriptions, sign it and hand it to the patient in 15 seconds. Instead, with electronic prescriptions, it’s one drug at a time. First look for the drug listed on the menu alphabetically. Click on it and wait for it to load. Then pick a dose, click and wait for it to load. Then pick the frequency of administration, click on it and wait for it to load. Then pick the number of pills and pick the number of refills, click and wait for it to load. Then click to review, wait for it to load, then click send and wait for it to go. Good god. Now you get to repeat this process for 5 other medications. It’s mind numbing.
- Retrieving data. With a paper chart, you can fan through an indexed paper chart and find the pertinent document in seconds. With EMR, you have go back and click, wait for it to load. You read one scan report and you might want to compare it to others. But then you have to find it and you have to click and wait for it to load and read one scan report at a time. With a paper chart, you can easily thumb back and forth and read reports simultaneously. It makes comparing reports very difficult.
With abnormal labs, you can thumb through a paper chart and see previous results and a quick summary of what disease the patient has. With EMR, again it’s click and wait to load, one page at a time. It’s tedious and a thorough review of an EMR chart is next to impossible because no one has that kind of time.
EMR was supposed to increase physician productivity. It clearly has failed to do that.
EMR was supposed to have improved safety. It doesn’t according to a number of studies. There are still mistakes made in ordering drugs and doses because of errors in point and click and non-review of the field before sending. And the same errors occur by pharmacists, nurses, and techs in taking off the orders. There are dangerous and perpetuating cut and paste errors through the hospital EMR systems.
EMR was supposed to reduce costs. It doesn’t. A recent study showed that EMR increases the ordering of expensive tests by 18%. Considering that these tests are many thousands of dollars each, that’s quite a bill to our country. Physicians get a menu and it’s just point and click. You order a CT scan and right below that is PET, so you click that, and right below that is MRI and you click that.
There was a recent comment in an editorial about how the very best minds in America being employed to devise ways to get Americans to click onto an advertisement. I’m guessing that EMR software engineering isn’t very sexy, exciting or well-paying because the products out there really stink.
Medical Myths originate when someone else writes the EMR program.
Myths disappear when doctors write their own medical reports.