<p>Cat, why is it a surprise, with EHR, that they need to document? Same deal as before. You either hand write and catch what you can, or enter it into a systematized format, in real time. Did you think docs didn’t keep notes before? </p>
<p>When my doc is done with my OV, he closes my file, goes to the next patient. Later, he makes and receives phone calls, some may be regarding me, gets lab results back (generally electronically, in his E-in basket, for review) and may add notes. Same as before, but conveyed in, again, “real time.” he can cross-reference on the spot. It’s an info exchange. </p>
<p>Electronic records are great if you are a patient. During my two month ordeal running from doctor to doctor it was a mind reliever that every doctor I saw had a complete record of my treatment up to that point and that I got a copy of everything discussed, diagnosis, and treatment prescribed before leaving the office. When one is sick it is often hard to remember exactly what the doctor said ( which is why they ususally recommend taking someone with you with,) but with electronic records that isnt necessary. Every medication I am on is listed as is every medication I am allergic to. Also, all the doctors I choose to have the new info are cc’d so I know at my next visit to them they all have the most up to date info regarding my health. </p>
<p>For me, the print out is the most important because when my H asks me what the doctor said I can show him the print out so he can see exactly what the situation is instead of me trying to recall from memory all that was discussed. </p>
<p>If any of you who are opposed to electronic records ever find themselves in the position of being pretty sick and having to go to several doctors and/or hospital you will be very glad your records are electronically stored. </p>
<p>“Lately, I have been handed an IPad that no-one in the office seems too familiar with and been asked to go through approximately 5 pages of check boxes. I generally just check no. But, it’s a lot of annoying and completely useless.”</p>
<p>Is this instead of filling out your history by hand? Imo, it’s easier doing it on an iPad then by hand. </p>
<p>eb, during my dad’s final long and complicated illness, I was extremely grateful that his primary doctor, urologist, surgeon, ED docs, and home health nurse all had access to his complete record. I can’t imagine what a nightmare it would have been if I’d had to try and remember all of that for every encounter. </p>
<p>Doctors are saying the EHR system doesn’t work well, takes too much time, and requires a bunch of irrelevant information. No-one is anti-computerized records.</p>
<p>You are right. My good friend is an internist and just cut back to half-time at 55. A large part of her frustration recently with medicine was directly related to the electronic medical records system. For every patient visit, it asked for the same information over and over again and there was no way to bypass this repetitive, irrelevant information. I don’t know whether non-medical bureaucrats developed these systems or not, but they are very time-consuming and do not necessarily lead to better record keeping. Many of the systems don’t talk to each other. </p>
<p>The upshot was that in order for her to get home at a decent hour each night and do the required electronic records keeping, she is cutting her patients by half. Less medicine, more paperwork. </p>
<p>Really? A 55 y.o. doc, who presumably was earning reasonably well all those years, cut back over the use of a computer? She had no alternatives and was just oh-so-frustrated? </p>
<p>You do know it is part of protocol that they are supposed to repeatedly ask some of the same questions, even if they asked before? Whether or not a doc has a computer nearby?</p>
<p>I said ‘a large part’, not the only part. It wasn’t the use of the computer as such. It was the dunderheads who devised a system that she felt decreased rather than increased her ability to treat the patients. And now she can work an 8 hour day instead of a 10 hour day. It should be up to the judgment of the doctor whether those same questions get asked week after week, rather than some bureaucrat who never practiced medicine in his life.</p>
<p>"For every patient visit, it asked for the same information over and over again and there was no way to bypass this repetitive, irrelevant information. I don’t know whether non-medical bureaucrats developed these systems or not, but they are very time-consuming and do not necessarily lead to better record keeping. Many of the systems don’t talk to each other.</p>
<p>The upshot was that in order for her to get home at a decent hour each night and do the required electronic records keeping, she is cutting her patients by half. Less medicine, more paperwork. "</p>
<p>I find this hard to believe after going to many different doctors since November. What I have experienced is the nurse comes in first, with her laptop, and asks the repetitive questions such as, "are you still taking such and such drugs, etc., and if there is any change, what brings you here today, etc., etc., etc. The nurse enters new info in computer. The info is then immediately in my record on the doctor’s computer - which the doctor looks over when they come into examining room. No need for doctor to ask those type of questions at all - and usually they proceed to asking me what’s going on - which the doctor enters into his computer, and then an exam. Whatever course of action is decided upon (new prescription, ordering of tests, etc.,) is then entered by doctor while he/she is still with me in exam room. Any prescriptions are sent immediately from doctor’s computer to my pharmacy while I am still in the exam room with him/her! Then when I check out - I get a print out of everything, including the doctor’s notes, that was done during the exam. There is nothing left for the doctor to do re: my records after the appointment at all! Even if the doctor notes I need a referral - that info is transmitted immediately to the person in the office who makes the calls to other doctor’s office. </p>
<p>If anything, electronic records are a huge time saver for the doctor, nurse, and other staff in the office. </p>
<p>What about the dunderhead who bought the system? Let’s point out, we are talking about commercial transactions between a private buyer (the doctor or medical group) and a private seller (the software vendor). If you don’t want to use bad software, don’t buy bad software. And don’t pretend that the government made the bad software you chose to buy.</p>
<p>If anything, electronic records are a huge time saver for the doctor, nurse, and other staff in the office.</p>
<p>That may be your impression as a patient, but that’s not what I’m hearing from this doctor. (And there are many articles one can google saying the same.)</p>
<p>It should be up to the judgment of the doctor whether those same questions get asked week after week, rather than some bureaucrat who never practiced medicine in his life.</p>
<p>I think you miss the point. It’s not some IT guy who dictates. I can barely imagine that. No, it is the medical profession’s own guidelines. Eg, the nurse or med asst can take your BP and the doctor is supposed to take it again. They are supposed to ask you, each visit, about certain symptoms, whether or not you told them in the last ten visits that no, you are not bothered by X or Y.</p>
<p>But there are also different types of visits- an Rx check will be more focused than a physical. Etc. And for that Rx check, the system can flag some of the questions the doc needs to ask, based on what specific meds it is. In the old days, he or she had to know and remember what could be a significant side effect.</p>
<p>All my docs’ practices have at least a couple of offices- I can see them at this location or that, depending on my need and their schedules. Eg, saw the urologist first at his main office, then his hospital space, next will be his other office. He has my records on his system, doesn;t need to have a file folder pulled the nght before- or transferred to the other place. My kids go to whichever location is offering the flu shots, it gets recorded in the main record. Our lab results show up. I get auto reminders on the mammo and colonoscopy, whatever. I find it amazing and very 21st century. </p>
<p>Tatin, I just told you what happens when I go to all my doctors. What else is required of them after I leave their office since everything is now done in real time? They don’t even have to dictate their written notes on every patient they saw that day so they can be transcribed! </p>
<p>Also, every question I am asked when I am at the doctors is directly related to medical issues about me that are important for the doctor to have. There is no “bureaucrat” dictating questions which need to be asked or getting the answers. </p>
<p>This article states that a study in Medical Economics found that physicians reported a 25% reduction in productivity due to EMR and 70% reported that the benefits were not worth the costs. </p>
<p>EMR in some form is here to stay no doubt, but I think it will lead to earlier retirements of physicians due to frustration with using the system or in some one-man offices, the simple economics of being cost prohibitive, particularly for someone considering retirement in a few years.</p>
<p>Flossy, how do you think computerized records get created? Someone has to enter them. I would rather my doctor enter the data, while I’m right there and can ask questions and get printout, than a nurse or transcriptionist, after the fact.</p>
<p>If the interface is bad, then it should be fixed. If its cumbersome, then it should be streamlined. But some seem to be saying we should do away with them.</p>
<p>Have we got any doctors here, who can explain what the doctors are doing in those hours after work when they’re filling out records, and why this is taking longer than it used to take pre-EMR? </p>
<p>My experience is like Emily’s. The nurse asks me questions before the doctor comes in, all of which are relevant, and then the doctor comes in and does doctoring, makes notes on the computer, and explains to me what is going on. Right then and there I can get a printout of findings and recommendations, so I can see that the findings and recommendations have already been entered in to the computer.</p>
<p>What’s the part that takes the doctor 15 minutes afterwards? What is she doing that takes her 15 more minutes, why does that record-keeping take longer than it used to take, and where in the list of the things required by EMR is that 15 minute task required?</p>
<p>I still find this hard to believe since paperwork was always a part of a doctor’s day and, while I cannot speak for everyone, most people I know find it much easier to do their work - whatever that work may be - now that so much is done on a computer versus having to hand write or use a typewriter. Plus, if this doctor is 55 - she has been using computers, at least for personal use, for at least 20-25 years. </p>
<p>But hey, if she want to reduce her patient load, she is certainly free to do that. </p>