Michael Kirsch, MD, roundly condemned EMRs as a guest columnist for the Cleveland Plain Dealer, on Christmas Day. He said it doesn't save time or money, promote efficiency, or improve staff morale. He knows of no patients who prefer it, and believes only health IT vendors are benefiting from the federal push for health IT adoption.
I respect Kirsch's assessment because the experience is his own, and no one else's. I will point out, however, that Kirsch's practice implemented an EMR system three months ago - at a time when it's well documented that practices are struggling with the steep learning curve. The cost of EMRs, as with any capital investment, is upfront. How expensive that upfront cost is depends upon which EMR model is chosen. I'd be interested to hear how things are a year from now for his office.
I also respect his concern that the art of medicine is devolving into point-and-click medicine. It is a point well taken, and something that one hopes regional extension centers are helping physicians address and learn how to interact with patients with a computer in the examining room.
I can attest to physicians being enamored or struggling with their computers or tablet PCs. My son's pediatrician is fond of his tablet PC. The pediatric practice did not have an EMR system when either of my kids was born. They have had an EMR system in place for about four years now.
During one visit I expressed concern about discoloration or lighter patches on my son's face. Our pediatrician knew what the condition was. He looked it up on his tablet PC and gave me more information about the condition during our discussion. He graphically documented the spots on my son's face, and we tracked the changes in subsequent visits.
Cool application? Yes, but I felt that it was a helpful tool that provided information in real time. More importantly, our pediatrician used the tablet PC as a tool. It was not intrusive to the patient-parent-pediatrician relationship but rather added to our visit. My son was self-conscious about the spots because I had brought it up, but our pediatrician calmed him down by telling him that it wasn't a serious condition and it often goes away on its own. He shared with my son the screenshot showing an illustration of his face and the spots, which fascinated him and thankfully deflected attention from his face to the screen.
My doctor's office also implemented an EMR system a few years after I was a patient. I normally see one of the nurse practitioners, and she definitely had to overcome a learning curve while using the system. Being familiar with the technology is probably the main reason why I wasn't irritated as a patient. I'm sure other patients felt the same way as Dr. Kirsch. The EMR has been in place at my doctor's office for a few years now. The nurse practitioner is now at ease with the technology. Yes, she does data entry during the visit, but I haven't felt it as intrusive.
Interestingly enough, my visits are longer than when the office was paper based. The discussions are longer, her questions are more thorough. Can I attribute it to the EMR system asking for more data? On the surface, it makes sense, though I can't say for sure unless I ask her the next time I have a visit.
This is not a tit-for-tat blog, really. I respect Dr. Kirsch's experience. It is his own and nobody can argue him out of it. Again, I would be interested to see if anything changes a year from now. Lastly, as we have seen from a number of conflicting studies being done about the benefits of EMRs and EHRs, there are plenty of advocates and detractors. When serious problems arise related to EMRs, they should be addressed. Both sides should always have a voice.
Photo by Eddie~S courtesy of Creative Commons license.
