By a practicing General Surgeon in the U.S.
The Inanity of Electronic Health Records
I wasn’t one of those who wanted to become a physician from a young age. But when later in life my career path led me to the field of medicine, the image I had in mind resembled Sir Luke Fildes’ “The Doctor”. The painting depicts a physician facing his dying patient, a very ill child.
But if you’ve gotten a checkup lately, you’re probably seeing a different side of your doctor. Touted as a way to improve quality, safety and efficiency, the electronic health record (EHR) is none of those. Rather, it has forced doctors to spend less time facing the patient and more time staring at a computer screen, with their back to the patient as meaningless information gets typed into cold hardware.
The Health Information Technology for Economic and Clinical Health Act, passed in 2009, promised Medicare and Medicaid payment incentives to physicians adopting the new technology. Beginning in 2015 however, those who do not adopt EHRs will be penalized, essentially mandating their use as physicians already struggle with progressively reduced reimbursement. Hospitals and private practice providers who participate in Medicare/Medicaid have slowly adopted the new technology and are now seeing its unintended consequences.
Before the era of third-party payers, the ‘old-fashioned’ paper chart was the way doctors painted their patient’s story. It was an insight into the thoughts, decisions and difficulties the doctor encountered in figuring out a diagnosis, planning treatment or managing complications. It was a daily log of the patient’s progress through their disease. The most memorable and most effective chart notes I remember from my training were those that my attending physician wrote in a sort of prose, where I was able to see the patient in my mind’s eye as I was reading. The paper chart retained the uniqueness of the patient.
While the EHR is chock-full of information, very little of it actually carries meaning to the physician and patient. For the physician or consultant trying to sift through the mandated, pre-determined data fields to gain insight into the patient, it is virtually useless as patients become indistinguishable. The patient’s story is lost in the cold, hard data rather than warm, colorful prose. Unfortunately, the doctor and patient have been driven further apart in the name of compliance. Rather than focusing on the patient, today’s doctors are forced to focus on the third-party payer through the flat artificial screen while turning their backs on the ones who they truly want to help.
[For the connection between EHRs and Obamacare, see Really? Obamacare Asks About Your Sex Life?]