CDC Says Less Than 40% of Doctors Use Electronic Records

I'm a physician and I'd like to shine an extra light on this subject. There is an important failing of most electronic medical record (EMR) systems that is never written about, but is important to understanding the resistance of medical practitioners to EMRs....

EMR's are normally designed to make records that look great to programmers and IT personnel, but difficult for the actual medical personnel to efficiently interpret. Even worse, the current trend in EMR deployment is to select whatever system is easily integrated with the existing IT systems and give little heed to what is the best EMR for the practitioners. IT drives the selection, not the end users who have to use it on a day to day basis.

Rather than a concise record that emphasizes important details and relationships, one often ends up with an unfiltered database including extraneous fluff that obscures information actually needed to take care of patients. You get lots of data, but it's hard to see the important information.

For instance, when one transfers care of a patient to a recovery room nurse, important things to note such as medical conditions, airway status, consciousness state, and vitals at transfer are buried in amongst numerous automatically generated notes like the gurney wheels were locked. Those much less important "details" get injected into an EMR to meet someone's sense of legal protection coverage and end up outnumbering the actual patient care data. They also get the SAME display prominence as the info that is actually important to the patient care.

It's frustrating when it happens, too onerous to go back and remove the automatic detritis, and outright dangerous when one has trouble finding the buried important medical details when reviewing a poor EMR record to plan an upcoming case.

EMR's are usually written to create an IT database and meet a programmer's idea of what is important to display. A physician's needs of what should be in the EMR are not the what a programmer, IT department, or hospital administrator desire. Sadly, the docs are the ones who have to use the system every day to take care of patients but are the last to have any real influence on what they are made to use. It is bad enough when the non-medical hands on experienced hospital admin and IT departments determine the tools, but a national EMR system is yet another step further separating EMR design and the front line user.

Mind you, I'm very much in favor of EMR's, but they MUST be well implemented for the users. For my part, frustration with a hospital mandated, cumbersome EMR prompted me to create an anesthesia EMR, Tethys that actually is formatted and works the way an anesthesiologist thinks. A good EMR is not just a database table!

As a fellow physician, I totally concur with the well written post above.

have you ever wondered why emr's are being shoved down physicians throats? platitudes are listed that they will make patients care safer, physicians can communicate better and cost will fall. where will all the data be stored and who will be privy to mining it? every specialtity has specific needs that are not addressed.

who really benefits? politicians, insurance companies, gov't agencies, hospitals, EMR designers, patients, physicians-- why not develope a system right before mandating it's use?

I have written records for my OB patients and all the nurses in my hospital prefer my records over all the others. They are consise and clear and complete. The original purpose of electronic records was to print volumes on every visit to justify higher insurance reimbursement. I have steadfastly refused them because they are nearly useless and hide vital information in mountains of automatically generated trivia. I abhor them.

Since there is already one system of EMRs that has been working very well for the last 12 years, why not develop a nation wide system following that particular system, which is our CPRS at the VA?

Form what has been expressed here, it seems that various EMRs used in the private sector are NOT well designed as they seem to cater the need of insurance companies more than the clinicians. However, that is not to say that EMRs are inherently inferior. Furthermore, the original purpose of EMRs was not for printing volumes of records for the insurance companies, but rather the ability to instantaneous review any note, any radiograph studies (not just reports), any lab, any medication lists, AND reduce the risks of mistaking illegible hand written records, with the added benefit of knowing when a specific note was looked at, when it was signed, when an addendum was made and signed, etc, etc.

I encourage anyone who thinks EMRs as inherently cumbersome and offers no added benefits to check out how our system works... A well designed EMRS indeed makes patient care safer, reduce medical errors, decrease possible delay of proper treatments, provide better communication between all clinicians and administrators, and reduce cost in general.