I Absolutely Love And Abhor My EMR

Cubs win
Marty McFly who first clued us in to the Cubs winning the 2015 World Series. Images from ESPN.com

I love the fact that I can leave the hospital after seeing a consult and drive home and create the note on that patient while watching the Cardinals play the Cubs in game four of the NLDS (I abhor the outcome of said game).
I love the fact that if I’m on call quietly eating breakfast at home and Mrs. Jones calls who is a patient of my partner Dr. B I can within a minute pull up her entire chart.
In this chart I can see a tiny picture of her and I can see all of the medication she’s on, all of the recent tests she’s had, and all the thoughts and diagnoses that my partner has conferred upon her.
If I did not have this information I would have to spend a super long time trying to extract it from her and extracting information from a patient on their medications, diagnoses and previous testing is a wildly variable (and often frustrating )  experience.  Said frustration is exponentially increased when the phone conversation occurs in the middle of a seemingly crucial sports event or a delightful meal.
I love the fact that once I’ve talked to the patient I can very easily electronically send in a prescription for a medication she needs to her local pharmacy without having to pick up a phone and go through a series of answering machine loops at the pharmacy.and after doing that I can leave a nice concise note for my partner in the EMR which he can read when he comes in on Monday (or if he checks his laptop from home he can see it instantaneously).
Most of what I  abhor about my EMR is not the fault of my EMR.

Meaningless Use?

Most of this comes from what is called meaningful use. Since the government has more or less forced us physicians into using EMR it needs ways to prove that we are using it effectively.
Early on what they wanted to see was that we were using electronic prescriptions. This  actually turned out to be a good thing because electronic prescriptions are awesome and now nobody has to see my illegible scrawl on a piece of paper and try to decipher what medication it is I want Mrs. Jones on.
But now meaningful use has moved beyond electronic prescriptions and into less clearly beneficial areas. For example it is very crucial now that we have an electronic patient portal for all of our patients.
Not only do we have to notify our patients that they can utilize the patient portal by setting up an account we have to make sure that a certain percentage of our patients are communicating back to us via the electronic patient portal
Imagine if you will that  Mrs. Jones is 85 years old and hasn’t the foggiest idea of how to set up an account over the Internet.  It is not going to be easy to get Mrs. Jones to communicate back to you.
In an effort to bolster the percentage of my patients that are communicating back to me by the patient portal I take up (what are arguably) critical minutes during the office visit trying to explain it to them and encouraging them to communicate by the portal.
I usually take this opportunity during the office visit to introduce them to my posts here on The Skeptical Cardiologist.
Mrs. Jones often believes that The Skeptical Cardiologist and the practice patient portal are one and the same but they are totally separate entities.
I have to say that when we have gotten patients to communicate back to us through the patient portal on their questions or their blood pressure reading and to give them results through the patient portal it has been really nice.
For example Mrs. Jones reports back her blood pressure over the last two weeks on the new medication that we started her on I am able to immediately look at those numbers and send a reply that says “these numbers look great,continue on with current medic ations”and I do not have to make a call or communicate with my assistant in anyway. I don’t have to pull up her information because it’s already in front of me and i can do that on my laptop from home (while watching the baseball game (there is a lot of downtime during baseball games)
Perhaps looking back a year or two from now I will say “boy I’m glad the government made me harass my patients into using the patient porta!.”
it’s possible, but by then there will be more meaningless use requirements that I will feel compelled to rant against.


5 thoughts on “I Absolutely Love And Abhor My EMR”

  1. This all sounds great until you read a recent article in AARP Magazine about the critical, but ignored issue of “enemies” that want to (and could easily succeed due to lack of security!) in cutting off all access to the Internet and shutting down our electric, water and other necessary utilities. Where’s the back-up? How secure is this system? Gives me the willies thinking about it. If it’s all so secure, why do we still have so much paperwork? Just saying…..

    • From what I hear, cybersecurity is going to be a huge issue for all of us in all professions.
      When the hospital computer system here at St. Luke’s develops a problem all work grinds to a near halt. Suddenly I can’t see any of my patient’s past records, meds or tests. If I’m rounding on a patient in the hospital, I can’t see their recent vital signs, labs or other consultant notes.
      Definitely a disadvantage of the EMR approach but one which fortunately has thus far only been brief and infrequent for us.

    • This is the link to patient portal info (http://www.stlukes-stl.com/patient-portal/). And there is the telephone method as described below.
      f you have technical issues signing on, please call the Help Desk at 636-685-7707. The Help Desk hours are Monday-Friday 8:30 to 5 PM. If you are calling after hours, please leave a voicemail and someone will call you back during our normal business hours. All requests to change an email address must be made in person at your provider’s office.

  2. Very interesting… now I understand why my provider has been bugging me to set up my portal!
    Somehow I was always able to find something more fun to do than setting up my patient portal, and I have not gotten around to it.
    But I guess I really should help the guy out and set it up.


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