Man and Machine

I don't keep up regularly with what's going on in my former clinic. Since just before I was leaving, they've been making the transition to fully electronic medical records. At the time, my experience with it was nothing but positive. It seems, however, that the process has come to a stage at which I'd have been driven crazy; were I still there but on the fence, it might have been the final straw.

I had lunch recently with some old friends; mainly nurses from our surgery center and a couple of nurse anesthetists, on the occasion of both of the latter recovering from recent surgery. Somehow my corner of the conversation came around to the software recently installed for inputing patient information, and the fact that it's not exactly user-friendly, especially for surgeons. A scenario was described that was like fingernails on a chalkboard.

The subject of electronic medical records has been frequently discussed in the medblogosphere; I think it's fair to say the majority opinion is that, from the point of view of doctors trying to record patient encounters, it sucks. And yet I've frequently commented that I generally thought the good far outweighed the bad. I may have spoken too soon, or, at least, based on a non-representative experience. In its first iteration, the institution of electronic medical records didn't change the way I did business. At that time, I was still able to dictate all my encounters and they were nearly immediately transcribed into the digital record. The only change was that I could get Xray images, consult notes, lab, instantly, from anywhere, without having to screw with finding the frequently-missing folders. But now, with the new format, as others have written, the doctors need to key information into a pretty rigid and unforgiving format, and it's gumming up the works. In terms of what's been described by other bloggers, that's old news. But it gets worse.

The program is so unwieldy, my anesthesia buddy told me, that it's slowing down the OR schedule. Surgeons need way more time to complete operative reports; the OR personnel wait in frustration until it gets done. Lateness, as I've written, burns a hole in my gut. But it gets worse still: because of the way the program is tied to current patient encounters, exacerbated by what sound like draconian penalties for lateness established by my former board (I was on it, once, and quit in frustration), it sounds as if that desirable human touch I was touting recently is getting squeezed into mechanized oblivion. The pressure to attend immediately to the record has gone amok.

In each exam room, I was told, there are now computer modules with sexy flat screens. Taking the history, docs cleave to the keyboard, asking questions while typing away, noses down. Some, I'd hope, might look up once in a while, but patients, they said, are complaining; and well they should. It sounds awful: impersonal, off-putting, humiliating, barrier-building. Some docs are refusing to do it this way, doing their typing back in their office after the visit. But doing so slows the schedule.

I remain convinced that the concept of electronic medical records is a good one: in any case, I'm certain the access issue is so important that there's no going back. Still, it seems there's a long way to go before finding a way to do it that enhances -- or at least doesn't detract from -- doctors' ability to use it efficiently. And willingly! Maybe voice-recognition technology will eventually advance to the point of being able instantly to digitize the sort of rapid-fire dictation that works so well when done immediately after the exam or operation. (I recall hearing old-days stories of surgeons at some big institution or another, dictating the op report from the prior operation to a stenographer while scrubbing for the next one!)

Every time I see my old cohorts I have a tinge -- a surge, really -- of regret that I burned out and bailed when I did. There's much I miss, and I think -- had there been a way to dial it back a bit -- I had more to offer. But on this occasion at least, I found myself thinking there's no way I'd have been happy with the current state of electronic affairs, and would likely either be screaming bloody murder, or producing another of my passive-aggresive (but brilliant) memos.