Actually, I Love My EMR …

One of the spinoffs of being an oncologist is that you do not to take the world for granted.  Each morning, I walk around the yard and smell the morning breeze. I am thankful for my children, my wife and my own health.  I am thrilled, if occasionally skeptical, to have the opportunity to pay taxes in a Country that I love.

So, who would believe I would take our Electronic Medical Record (EMR) for granted?

I know, shocking, isn’t it?  How could I overlook a key factor in the success of our practice, ever since we ditched paper records, 13 years ago? Nevertheless, it is true. Day-by-day, the keyboard and screen became just another device, like a stapler, paintbrush or pocket comb.   I began to use it out of simple necessity, and neglected to sit in awe of its power and glory. I ask the geeks of Silicon Valley to forgive me.

We have been binary in our office for a long time, but not in our main hospital.  In the office, everything flows by electron, but at the hospital we have been using a kind of EMR-light, call it E-decaf.  Maybe we turn on the machine to check a few labs, order the occasional test, and perhaps send an email.  Thus, even though the docs of our practice spend more than a hundred-fifty hours a week on the wards taking care of 60 patients a day, we were still paper-binder-chart-bound.

But, last week it happened … we crossed the Rubicon … in a blinding flash of bits and bytes, clicks and clacks, copy and paste, we went full-on-no-holds-barred, every-piece-of –data-for-itself electronic and converted to the EMR.  It was glorious!

In the hospital, I had long gotten used to the appalling inefficiencies of the crayon and papyrus world.  First,  find the chart ( good luck… I am sure I have lost a year of my life hunting ). Then, read the prior notes ( which for many doctors, including yours truly, is impossible ).  Find the labs.  Find the X-ray reports.  Check the images.  Call the lab and radiology for the labs for the results that you could not find.  Seek and then check the vital sign clipboard.  Read the I&O record (different clipboard).

Now, there’s time, barely, to see the patient.

Then, painfully, ridiculously, illegibly, write down what you just found, repeating everything you also wrote yesterday (except what you forget or can’t read, which is probably critical) and then put the chart back in the rack (maybe), so that the next doctor can start this whole process over again.

You think I am kidding? Exaggerating? Not the tiniest bit. What I described is what every doctor using chisel-stone-tablet records does every day with every patient and if you have a lot of patients in the hospital it takes a very long wasteful time and is guaranteed to result in error.  Ask any doctor to pull any binder at random from any chart rack anywhere and read it carefully and there is an almost 100% chance you will find a mistake in that record.

In brilliant contrast is the EMR, I used today.  No need to find the chart, just a computer, and we have lots of those. Open the patient’s file.  Read the clear notes from other doctors consulting on the case. Then, turn to my note from yesterday.  Download directly into the note, with a couple of clicks, today’s labs, x-ray reports, pathology reports, I&O, medication lists (ordered & actually given), vital signs and any other relevant data.

See the patient (which I have more time to do).

Modify my note with today’s findings and conclusions.  Write, in the computer, any new orders.  The orders are instantly checked for allergies, compatibility, dose, availability, redundancy and communicated to the proper department.  Complete.  Legible. Efficient. Accessible and transmittable (via encrypted form).  Even fun.

The quality of medical care because of clarity, accuracy, speed and the quality of communication is multiplied, probably exponentially. Problems are not forgotten. Errors are quickly identified. The valuable efforts of patient and professional are not wasted.  The time needed to create extraordinary medical records is cut at least in half.  The medical record is not just another device, like a pencil, tape measure or paper chart. It is a tool to guarantee, amplify and create quality.

Is the future here?  Are present day EMRs the Holy Grail?  Not yet. They still have major problems in data input, across system compatibility and universal access. However, they a stunning technology that saves cost not only by saving time, but by improving the quality of the record and therefore the quality of care.  In the future, not to far away, EMRs will interface with medical information and research databases and work with each doctor with each patient on each day to assure the most accurate diagnoses, the best treatment and the best chance of cure.  Even now, they are revolutionary.

Therefore, I ask the IT guys in the trailer out-back to forgive me.  I did not mean to take them, bowtie-pocket protectors and all, or their electronic children, for granted.  Never again.  EMRs are not just a brightly colored tool; they are the key to a future of medical quality, health care delivery and experimental breakthrough.  How very cool it is to practice e-medicine today.

James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

10 replies »

  1. This is a great post – I completely agree that electronic health records can help medical practices be efficient, effective and organized! Were you talking about a particular EHR? I just had a demo for drchrono and after reading this article, I truly feel ready to take my practice to the next level with an EHR!

  2. The types f names of grandparents ? ha. The batches of meat are browned, remove to a plate or rimmed baking sheet while you continue with the others..
    GHD Outlet
    [url=http://rochp.org/wp-content/ghdoutlet.php]GHD Outlet[/url]

  3. EMR sounds great. The interference of technology in medical field has provided easiest way to diagnose any disease and the keeping the record of patient is very necessary any how, any software does have any bug so it’s better to create bug free systems.

  4. In my few posts on this blog I keep asking about privacy and ask for references to where this has been debated. Dr. Salwitz raised it in a previous post (that I quoted in post comment above)….see law prof quote below:

    “One thing that hasn’t happened yet….and I don’t know when it is going to….I hope it is soon….and that is the digital records….digital medical records…..means that the NSA isn’t going to have to monitor your cell phone or emails to figure out what illnesses we have. It is all going to be digitized and within reach….not encrypted….or not encrypted enough to prevent then from accessing it. So every doctor you have seen and every shrink you may have talked to is going to be something the federal government is going to have access to because of this mandated digitization. We haven’t got there yet. The public hasn’t focused….even the intelligentsia hasn’t focused on this yet.”
    Randy Barnett
    Comments January 7, 2014
    Randy E. Barnett is the Carmack Waterhouse Professor of Legal Theory at the Georgetown University Law Center

  5. Great post… I know quite a few bow-tied, pocket protected geeks who would appreciate the feedback. They may even venture out of the basement and into the light of day in celebration.


  6. Dr. Salwitz:

    I completely agree with a statement you made in a previous piece (see your statement below) about patient control…..I just think it is naive to think it will be done in the manner you prescribe. But perhaps there are provisions of the ACA or existing policy that will lead to the patient control you call for. I would appreciate it if you would provide some reassuring arguments, explanations or data.

    Your statement: “However, it is vital, as we pursue this technology, that we guarantee each person has control over his or her records. Patients must be able to determine who can and cannot see their E-Chart, whether it is other doctors, pharmacies, insurance companies or hospitals. They must decide which parts of the records are shared, as well as when and why. In much the same way we share our bank accounts, deciding who can withdraw funds (i.e. automatically paying your mortgage each month) or who can deposit dollars (i.e. electronic payroll deposits), as well as who can read your bank statement (or not), records must be under the tight control of patients.”


  7. This EMR sounds fantastic. James, which vendor is it? Surely they would enjoy this public praise of their product.

  8. @ James. You do raise a great point here. NIce post!

    There’s been a lot of negativity flying around about this technology. Many of the complaints are justified. The usability questions need to be addressed by developers. The questions about the proper use of data need to be addressed by society.

    This may be a lost phase of Gartner’s technology adoption cycle. The “loud grumbling and wishing that everything would go back to the way it used to be in the good old days before everything changed” phase ..

    This grumbling phase is of course generally followed by the “figuring shit out phase”