On a routine office visit, a patient asked why, despite our office being technologically advanced in many ways, doesn’t use an electronic medical record (EMR). Good question.
Being somewhat of a gadget and computer geek, I’ve dabbled with EMRs for over 20 years. More recently, in private practice, I’ve looked seriously into a few dozen options, but nothing seemed attractive, and the features and functionality of current EMRs didn’t justify investing thousands, or even tens of thousands of dollars, not to mention probably dozens, if not hundreds of hours of time learning the new system, and years before we get a return on investment. Plus, since these programs are designed mainly for primary care providers, I’d only be using about 10% of the features that I’m paying for. Not one colleague that I’ve spoken to is ecstatic about their experience with EMRs.
Another major reason is that expect for being able to go paperless, and becoming more efficient with patient information in-house, with the lack of a national standard where doctors and hospitals can communicate with each other (like banks), there won’t be any advantage to going electronic.
One common buzzword in the EMR field is "point-of-care" documentation. This means that you’re inputing information while you’re interviewing the patient, saving time. If you’re taking copious notes while interviewing someone, notice that more than half your time is spent jotting down notes, with your eyes on your notebook (or tablet PC). You’re not focused on the person you’re interviewing. This is what I found so frustrating. I’m getting the facts down, but I’m missing the message and story that the patient is telling me.
There’s a study that’s often quoted that looked at the relative impact of facial expressions and spoken words. What the study author concluded was that only 7% of real communications happens with words, another 38% through vocal tone and pitch, and the remaining 55% is through facial expressions and body language. What this study implies is that without seeing or hearing any nonverbal cues, it’s easier to misunderstand what the person is trying to convey.
When I tried to take notes while seeing a patient, I found that I wasn’t able to determine the true wants and needs of the patient, despite "hearing" their main problems. There was ultimately a disconnect between what I perceived and what the patient ultimately wanted. There’s always another story behind the obvious reasons why they come to me. When I went back to giving my undivided attention to the patient without being distracted, patient encounters were much more rewarding and satisfying. Unfortunately, with more EMRs being used and doctors’ focus on the computer tablet rather than the patient, the doctor-patient relationship will deteriorate even more.