Well, it had to happen...the Angry Allergist has to weight in on one of the most important topics in medicine...the one item that's gotten even more hype than the iphone...yep, you guessed it...the electronic medical record--or, EMR.  This little baby's supposed to do everything...I wouldn't be surprised if it even offers a cure for global warming.  And everybody's behind it.  The government, medical associations--you name it.  It's a sacred cow that nobody wants to criticize.  ...which makes it a perfect topic for my blog, right??

Before I weight in on this subject, I want to inform you of a few things:  First, we've been using an EMR in our office for about a year now, so I've had experience in dealing/grappling/struggling with it.  We have a superb EMR in-house support staff that has (in my opinion) worked as hard as conceivably possible to produce the best quality EMR designed for us.   Finally, by nature (as a former engineer), I LOVE computers.  (The last laptop I bought was tricked out with a dual hard-drive RAID 0 configuration with an overclocked CPU).  Now, that being said, I'll weight in with a few thoughts.

Perhaps the old adage, "one picture is worth a thousand words" will suffice.  Check this one out:

Recognize it?  When Leonardo Da Vinci created his painting, he started with a blank canvas, and painted this masterpiece.  But if he was using an EMR to create his masterpiece, I think it would look something like this picture below:

Not quite the same, is it?  Well, that's what I seem to get with the EMR.  In truth, some of the "softness" of the medical record just seems to be missing with the EMR.  I can't explain it.  I just know it. 

Oh sure, there are what I euphemistically call "point and click" patients, where the history is concise, the problem focused, and all the boxes can be filled easily on the EMR.  But for the complex patient, the ones who can't be "precise" about dates/times/relationships, and relate their history in a digitally coherant fashion, then placing them in an EMR is a real challenge...

And therein lays the danger of the EMR.  The physician may become so focused on "fitting" the patient into the EMR that he/she loses focus on what their primary goal is--to listen to the patient, and figure out what the heck is going on with them.  For example, In a a recent article in the Annals of Family Medicine, it was found that EMR useage did not guarantee better diabetic care.  In fact, the researchers found that in offices that used electronic medical records actually offered poorer quality care compared with those doctors who didn't use them.  As a consulting specialist, during an initial patient interview, I am often faced with a plethora of records the new patient brings in with them for my review.  They bring in complex typewritten histories.  I have to assimilate this information, make relationships, and solve problems. Rapidly.  I need to shuffle papers, circle lab tests from outside sources, frequently refer back to several lab tests, etc.  My mind works fast.  It's on the move.  Documentation, point-and-click be damned.   

The EMR is an excellent repository of data.  And you CAN do neat things with digitized data.  But I am not (first and foremost) interested in depositing that data.  I am interested in using the data to solve specific problems.  The EMR is here to stay.  I'll still use it, but will (I suspect) like most physicians, learn to make peace with it.  I still start (like Leonardo) with a "blank canvas"--my visit notes.  And I scribble down what seems important.  I make relationships, write down a few thoughts.  And solve problems.  And then, as time permits, I "point and click" to enter the most important data into the EMR.  Later.  When the patient's gone.  I minimize EMR use with the patient in the exam room.  Eye-contact and personalization of the interview can insufferably worsen otherwise

In short, the EMR exists FOR the patient's benefit--and not the other way around.  I suspect--and worry--that our health care system sometimes reverses this order...and if it's put the other way around and it ends up becoming the focus of our attention--and not the patient--then it just morphs into another sort of "EMR"--the Extremely Mediocre Record...and let's hope this doesn't happen....

Later, Dude