For the past 6 weeks I and the several hundred other ambulatory physicians who belong to the St. Luke’s Medical Group have been going through a difficult transition; we’ve changed the software that we use to manage patient information.
Seven years ago we made the painful transition from paper patient charts to an electronic health record (EHR) called eClinical Works. This process required lots of scanning but by 2015 when i wrote “I Absolutely Love and Abhor My EMR” I had become very facile and comfortable with the software.
During this current transition to an EHR called Cerner, we had to drastically reduce the number of patients seen per day in the office as we learned how to streamline workflow and as bugs were worked out of the system. We have struggled mightily with the simplest of tasks such as renewing patient prescriptions, scheduling tests, or reviewing test results. Stress levels for everyone, assistants to physicians, went through the roof as we spent hours clicking, refreshing, and re-entering data ion our frequently crashing computers.
My apologies to all the patients that had to be rescheduled during this process and to any who had to wait excessively for something as simple as a follow up appointment. The bugs aren’t completely out but we are making progress.
And my apologies to readers of the skeptical cardiologist as this EHR transition plus other work and social demands have left me no time to write.
Atul Gawande, a surgeon and excellent writer has written a great piece for the New Yorker entitled “The Upgrade: Why doctors hate their computers.” which nicely details why doctors have reached a point where they “actively, viscerally, volubly hate their computers.”
Prior to our Cerner transition I was in a good relationship with my various Mac laptops but for the last 6 weeks interacting with the EHR has made me a stressed, anxious and borderline depressed physician.
I am only 6 weeks into the new EHR but Gawande, who has been using Epic* since 2015 writes that “I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me.”
“A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient-whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. These tasks spill over after hours and the result has been epidemic levels of burnout among clinicians.”
The first 6 months of any EHR transition are by far the most difficult as all users gain proficiency with the workflow and as most patients are newly entering the system. Hopefully, 6 months from now the computer will not be my master and I and my staff will not be burned out.
*Epic is the most widely used EHR by ambulatory physicians. Gawande makes the claim that “more than half of Americans have their health information in the Epic system. ” This graph indicates Epic is definitely the market leader but seems to have less than 50% of patients.
On the other hand, this recent report indicates that ” Cerner leads the worldwide EHR market with Epic taking the second spot, Allscripts in third and GE Healthcare at fourth.”
The skeptical cardiologist has previously agreed with widespread dietary guideline recommendations that encourage most adults to consume a variety of fish, preferably oily types (eg,