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July 28, 2019

How Electronic Medical Records have Changed the Practice of Medicine

electronic medical records

Electronic medical records (EMR) have altered significantly the practice of medicine. Some of the effects of EMR are positive but many are negative. EMR or electronic medical record is sometimes used to mean electronic medical record.

Nowadays physicians must use an electronic health record system if they plan on billing a patient’s insurance company – commercial or government related.

Electronic medical records do create some efficiencies with documentation of a patient’s medical record, but they do create significant time inefficiencies for physicians and medical staff.

Positive Effects of the Electronic Medical Records

Use of electronic medical records does facilitate sharing and sending patient medical information. And, EMRs make prescribing medications easier and with fewer mistakes – one the prescriptions are legible and there are safe guards in EMRs that warn physicians of possible alergic reactions and drug-drug interactions.

EMRs save space in the doctor’s office from. Medical records rooms are no longer needed and time is saved from not having to shelve and retrieve patient charts. The EMR is portable and physicians can attend to patient issues during the off hours much easier than with paper charts.  The downside to this as a physician is most physicians now find themselves working in the evenings, weekends, and even when on vacation.

EMRs enable researchers to pull and analyze data that can be used in improve population health. They also improve the monitoring of preventive health screens.

How EMR Has Changed Medicine Negatively

The days when you and your doctor could chat un-rushed and when doctors would actually make sustained eye contact with you are over with the advent of electronic medical records (EMR). Most physicians who practice during the good ole days of paper charts feel the EMRs slow them down. I certainly do.

Overall, the patient-doctor encountered has become less personal.

For every hour seeing patient doctors now spend two hours on electronic health records and desk work. See this study the title of which is misleading as it under states the time doctors spend on EMRs.

To make up for this lost time most physicians are now busy clicking a mouse looking at their computer screen as they talk to you occasionally coming up for air to look at you. Multi-tasking is not healthy. It is difficult to listen to what the patient is saying as you are typing something else or ordering lab tests.

Before EMR I would see a patient, occasionally break eye contact to jot down a few notes, exam them, formulate a treatment plan, and then dictate a thorough note in one to two minutes – maybe three if a complicated case. Sometimes I would dictate the note immediately – sometimes later. Seeing patients always took precedent over chart work so if the next patient was ready to be seen the dictation on the previous patient waited. If necessary, though, I could dictate a half day’s worth of patients – usually 10 to 12 – in one block of 20 to 30 minutes recalling all pertinent details as I was able to listen to the patient with undivided attention.

EMR easily adds 5 to 10 minutes of time per patient, at least for me, to complete the chart work for that visit. Multiply that by 20 patients a day, and it becomes a suction of time that adds little to the quality of care.

But, there are more inefficiencies with EMR that add time. Most physicians who used that “outdated” paper chart found them more efficient. It was easier and faster to locate lab results, consultation notes, and reports on diagnostic studies with the paper charts. Reading from a laptop an eight page hospital discharge summary that has been scanned into the EMR can be challenging. The print is very small and many times it has to be printed out to adequately read. And, all of that adds time.

Plus, there is a lot of what I call “resume padding” with medical records these days. More of that has to do with new billing and coding requirements than EMR, but EMR contributes to the problem. Medical reports are much longer than they need to be, and it can be hard to find the information that really matters and affects patient care. More and more of the chart is documented for coding and billing purposes than for patient care purposes. Thus, it takes longer to read reports these days adding more to the inefficient use of time.

Of all the information that is now scanned or electronically deposited into a patient’s EMR I wonder how often a document is ever retrieved and reviewed again. In other words, given all the time spent documenting, collecting, and saving data, what percentage of the EMR do we ever retrieve and utilize. My hunch is very little.

Physicians as Clerical Workers

Probably the biggest frustration EMR has caused is this. It has turned physicians into clerical workers. During my residency training one of the teaching faculty said, “A doctor should only do those things that only a doctor can do.” If someone else can legally and ethically perform a task, let them do it. A physician’s time should be spent practicing medicine – focusing on patient care.

With EMR only doing those things that a doctor can do is virtually impossible. We now order labs and diagnostic tests and request consultations through the EMR. In the old days we would simply tell our nurse or medical assistants and they would order these things as we moved onto the next patient. Instead, now we have become expensive data entry people.

At Central Ohio Primary Care Physicians we have over 400 physicians. We are the largest physician-owned primary care practice in the country. Some of our physicians have had to reduce their daily patient load by 25% to  33% because of EMR. That reduction does not come along with a 25% to 33% reduction in practice overhead, however. The overhead pretty much stays the same. But, that is another story.

Our group is looking at several options to lessen the burden of EMR on physician time-management as the additional time burden has led some of our doctors to retire sooner than they wanted.

The more time doctors spend doing paper and computer work is less time they can spend with you. You are the main reason most physicians become doctors. Yet,  many times nowadays patients take a back seat to the business of medicine.

Summary

While electronic medical records have many advantages, saving time isn’t one of them, which makes EMRs different than most new technolologies.

 

electronic medical records

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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