<p>^What for?</p>
<p>And welcome to college confidential</p>
<p>“And I can guarantee you that there will be abnormal results that get lost in the database.”</p>
<p>OK, so here’s the new “system:” A hundred thousand doctors, nurses, assistants, clerks, transcriptionists, interns, volunteers, etc. will enter data … each using his/her own knowledge, training, initiative, and biases. Oddities will get into the system. The real question is … how do you get them out. “Dr. XXX I noticed that my blood glucose from 2008 is listed at 126 rather than 106. How long will it take to get this changed, and revised data out to my health insurer so my coverage can be renewed?”</p>
<p>My Doc is part of a 4-physician office that switched over to EMR. Hates it. As Shrinkwrap pointed out, the Doc spends most of the consultation entering data the laptop screen. Stand up, check my pulse, sit down, enter data. Stand up, check my carotid, sit down, enter data. Stand up … </p>
<p>Who ever though turning Docs into Data Entry Clerks was a good idea?</p>
<p>Entries in medical records can never be changed once they are signed off on. One can enter an addendum that will show a timestamp of the date and time of the correcions but the incorrect result will forever be there, and could possible go out to others without the addendum. </p>
<p>A letter of explanation to an insurance company will usually work. But I can see someone getting denied for insurance/life insurance based on an incorrect entry, and that person might not ever know why or be able to correct it. </p>
<p>There is much good about an EMR/EHR. But there are problems. Big problems. </p>
<p>I am contemplating using a scribe, a medical assistant who will tick on the bubbles, etc and answer the questions electronically as I ask the questions. As a woman, I often do not need a “chaperone” in the room during history or physical exam taking. I can ask and get answers to personal questions, and patients feel comfortable. So now I either have to sit and ask and enter into the tablet or desktop, or have a scribe in the room to do it for me. It is rather discrete to sit or stand and take notes. I could quickly dictate afterwards or write out an impression and plan. The technology changes everything. And there were times I would talk, and write down answers in a delayed fashion when the questions got personal. The patient did not think I was writing down every word. Now, she will know that I am entering the data, there will be no thinking and hoping my handwriting will be decipherable only by me, and she will know that all those secrets are there for anyone in the office to see, including the high school and premed college students volunteering to get hours…</p>
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<p>Personally, I think an entirely digitized medical record is better for security and confidentiality overall. With paper records, anyone with physical access to the folder (and you’ve all seen the stacks and stacks of records behind the desk at your doctors office) can see, edit, destroy, etc. the record and there will be no record (no pun intended) of that. Also, paper records are easier to lose and are in general a bigger pain to look through, esp when a patient is elderly and/or has a ton of comorbidities. An EMR is encrypted, accessible from anywhere the provider is, and every single access or edit to your record is logged. That being said, any system is only as good as its weakest link, and for the EMR that is the password and practices of the users - but this can be taken care of with password requirements and automatic log-off, etc.</p>
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<p>As for this and other posts like it, well… those physicians just aren’t using the EMR properly. And that’s perfectly understandable if the physician is older, not used to using computers, or just is new to the whole EMR game. Did those physicians sit there and enter every finding individually like that when they were using paper charts? Probably not, so why are they doing it with EMRs? Personally, I have no problem taking a history/physical without ever touching the computer and then leaving the room to create the record - and it’s much faster than if I wrote it. But it’s nice to have a computer in the room to be able to show patient’s their lab results or to pull up their CT or X-ray and go through it with them. Also, prescriptions can be sent immediately to the patient’s pharmacy, orders sent to the hospital, etc.</p>
<p>And re: being data entry clerks, what do you think physicians were before EMRs came around? All that information still had to be logged somewhere (i.e. a paper record). Personally, I can type much faster than I can write - which brings me to another benefit of EMRs - they are always perfectly legible. I have seen so many medical records where I doubt even the person who wrote them could figure out what is written. EMRs take care of that problem completely. </p>
<p>Obviously, I am a huge fan of EMR’s. They really take care of a lot of issues with paper charts. Not saying there aren’t downsides, but the benefits far outweigh the problems.</p>
<p>Icarus, if you use one, which one, and what specialty?</p>
<p>What I do (C and A Psych) is keep a paper record with things that would be text entries, but enter stuff that lends itself to check-boxes and simple drop-downs, and collecting data like age, gender, diagnosis, medication, tests, symptoms, etc. That way when I need to communicate with another doc, I send a printout of that sort of stuff, though it really doesn’t tell “the story”.</p>
<p>For my husband (FP), I think it has increased the number of hours he works without reimbursement. He has always charted at home, but now he has access to so much stuff from home, and he seems to need to “finish” everything. Me? not so much…</p>
<p>I’m just a medical student, so I get to use an EMR through a variety of specialties as I go through my clinical rotations. The EMR used at my school’s teaching hospitals and most of the other clinical sites (there are exceptions, of course) is EPIC. And having seen some of the alternatives, I have to say that Epic is the best I’ve seen. (From what I understand, it’s also pretty pricey) It’s very detailed and customizable, and pretty user friendly once you get used to it.</p>
<p>Have you used it in psychiatry?</p>
<p>Not yet, but psych is actually my next rotation, so I’ll get back to you in a few weeks :)</p>
<p>My primary care physician and my dermatologist are both struggling with the transition to electronic medical records. Neither is a computer expert, and both have solo practices. So when problems arise with the system, it is extremely disruptive to their work.</p>
<p>And they definitely look at the screen and ignore the patient. </p>
<p>I can see some advantages – the system tells the doctor when the patient is due for routine preventive services, like colonoscopies and immunizations, and it generates electronic prescriptions, which decrease confusion at the pharmacy. But this comes at the cost of spending time actually interacting with the patient.</p>
<p>H has pointed out something that is true elsewhere but I think applies here, too. What technology has really done is make everyone do things themselves. H is a college prof. There used to be a secretary who typed papers, maybe took dictation, types and sent (and sometimes composed) basic correspondence, made copies, and sent out articles, for instance. Since the advent of personal computers, you end up doing all that yourself. I have a secretary, but she doesn’t do what used to be secretarial work because I do that myself. The same appears to be true here. Doctors used to practice medicine and make relevant notes. These were either conserved as paper records or entered in some way by a medical transcriptionist or other office staff. Now doctors have to do that entry of info themselves because of technology. Good and bad to both sides. However, there will be a transition period until the younger generation who are completely tech savvy age.</p>
<p>Wife’s doctors used to dictate the info and send it off to be transcribed in the Midwest. Now most of those people who did it as a nice side job fromhome are out of luck. My DR looked like a deer in headlights first time I saw him with the EPIC system. By the next year he was a pro and liked it.
Paper files get lost and mis-filed all the time. Computer files always there so no file searches to find the DR left it somewhere and forgot.</p>
<p>We are in the midst of a conversion to EMR. We have a student working for minimum wage. She is very efficient, and very detail oriented. She has been working since June and has scanned about 20-30 charts a day. I figure it will take about 1 year to get all of our practice charts scanned. Especially since at the end of summer, she goes back to college full time, and the scanning will only be on an “as needed” basis.</p>
<p>So when are physician offices going to get rid of those old-style examination tables … you know, the ones Docs used to stand beside during the examination? It’s, um, unsettling sitting on the examination table looking down at your Doc entering data on his laptop.</p>
<p>BTW, as a patient I used to get test results, etc. mailed to me before the appointment. That was nice, as I could prepare any questions I had ahead of time. No more. I haven’t seen a test result in over two years.</p>
<p>well, i happen to have a lot of insight into this topic. i have worked with electronic medical records for 11 years as a doc (think government). extremely helpful in record keeping- keeps info current and duplication of tests and consults from happening, probably saved lives and you get used to the interaction. telemedicine interaction is another story. now for the paper chart thing- having left private practice and having had records in paper form for many many years i discovered you can scan the chart BUT still have to have secure original (paper) retention for like a very long time depending on the age of the patient and the state laws. soooo, if i were in private practice right now- the EMR would be cost prohibitive to keep up but would be preferable- do you know how much it cost to store med record charts? alot…</p>
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<p>Another fan of EMR. My primary physician has been using them for a couple of years now. Whenever I have any lab work done, and the results come in, I get an email telling me to sign onto my account for results. Many times these emails come at night, so I figure I’m seeing them before my physician is, unless he’s regularly checking his email late at night. The program they use also allows you to go back to previous years, and create a graph or chart of blood tests that you’ve taken more than once (i.e., cholesterol, iron, thyroid, etc.). It keeps track of immunizations, due dates for diagnostic testing (when your last mammogram, colonoscopy, etc.). </p>
<p>The nurse is the one who takes all of the vitals and records them in the computer, so the physician is only typing in the narrative of the visit, which I think is better to do as you go along, as opposed to trying to recall information several hours later and several patients later. I have a couple of prescriptions that I do mail order - a three-month supply at a time - and now when I do my yearly visit with him, he electronically refills them with my mail order prescription company. I don’t even see a written prescription; a few days later, they arrive in the mail. </p>
<p>As someone who has had to chart electronically before, I really appreciate that my physician is filling out the form as we go, and that anything that needs to be taken care of, has been done before I walk out of the office.</p>
<p>One more benefit… if I have any tests, shots, medication changes made or given by another physician, I can email my doctor with this EMR system, and let them know. They then add it to my chart and I get a reply back saying they have received the information and have noted it on the chart.</p>
<p>Just went online and checked; they also use Epic.</p>
<p>Also, whenever I have a visit, I a Visit Summary sent to my email after the visit.</p>
<p>Epic is commonly used but there are many others out there and when folks go with the lowest cost program out there, there are often incompatible, which is another big roadblock.
I ask & have the lab send me a copy of any tests which are performed & it works pretty well for me.</p>
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<p>They may be there, but they can’t always be accessed. A few months ago, I had an appointment with my doctor to discuss the results of a medical test. I happened to have the first appointment on a Monday morning following a weekend in which the EMR system had been upgraded. Naturally, it wasn’t working perfectly and my doctor could not pull up my test results. We had a general discussion about the condition – nothing I hadn’t already learned on the internet – but she could not give me any information about my case. As it turned out, there were some anomalies in my case which we’ve been dealing with over the phone ever since, inefficiently. We could have had a simple 10-minute conversation that day IF the record had been where it was supposed to be. That visit was a total waste of time and money.</p>
<p>Have had that happen with an office that had a paper system. I had been seeing the cardiology practice for about 6 months and had MANY expensive tests with them. I also had a LONG (about 30 minute) discussion with one of the partners about a possible anaphylactic reaction to dye preservatives used in the nuclear stress test so we decided it was best for me to just have a plain stress echo w/o any dye. When I had a chance to read my chart, it had NOTHING about the conversation OR my sulfite allergies or much of anything else! </p>
<p>Fortunately, I had requested a PRINTED copy of my test results so I could have the cardiologist who had ordered them go over them with me. There was NONE in my file and he had no idea why I was there for my appointment. He wanted me to have MORE testing when he didn’t even have the courtesy of reviewing the test results for the test he had just ordered! He also proceeded to order the test that his partner said was VERY DANGEROUS for me with no idea about the conversation or dangers involved. He also had the nerve to arrive very late for the appointment and answer his cell phone and walk out after only 5 minutes talking with me and then had the further nerve to say that I had to hurry because he was running late! This was just before he ordered the test I refused & vowed never to return.</p>
<p>I never returned and informed both of my referring physicians that their practice was VERY dangerous and going to kill one or more patients with their sloppy practice. I was also incensed that I waited forever to see them, only to be told after waiting in the waiting room for literally hours that the doc I was scheduled to see was NOT coming in that day. I should have known then never to return, but I wanted him to interpret the test that HE had ordered. They wanted me to do another EKG with a doc I had never seen before WITHOUT walking about why I came to the appointment at all! AWFUL practice!</p>
<p>Sorry for the vent. Unfortunately, they are supposed to be one of the best and busiest cardiology practices around! I saw many, many patients waiting forever in their waiting rooms. </p>
<p>Paper or electronic records–both can have their problems.</p>
<p>Someone further back wrote that “multiple departments can view the EMR at the same time”. Not true with every system. Our experience has shown that when one dept or even one person is in a patients medical record, the other depts or people get a message saying “locked out–record in use elsewhere”.</p>
<p>^ With Epic, at least, multiple people can view a record at the same time, but you can’t have multiple people editing the same record at once, which makes sense. If you try to go into editing mode on the note while someone else is doing the same, it gives you a read-only version of the note and tells you who is currently working on it.</p>