For all who hate computers in medicine: here’s what we got before.

By e-Patient Dave DeBronkart

The photo below shows what “visit notes” from a doctor appointment might look like in the era before computers. Just two days before my first speech where I said “Gimme my damn data,” I had an ENT visit, and on the way out I asked for a copy of the doctor’s notes. The clerk snickered out loud and showed it to me, saying, “If you really want it….”

No joke; this is what the doctor had recorded.

Visit notes from my ENT appointment, Sept 15, 2009

The horrible usability of many of today’s EMRs has understandably caused a lot of bitching from their users (clinicians). I totally empathize and I want it fixed. I’m grateful for the dozens of very smart people whose years of study, training, and clinical experience helped save my life in 2007, and I want them to have a good life, not one filled with horrible machines.

But the remedy for usability problems is not to go back to paper, it’s to force vendors to fix it. (I spoke in 2010 and blogged the video in 2011 about a major reason for the usability problems: the EMR executive who was strongly rumored to have said that usability would be a system criterion “over my dead body.”)

Another example: Peter Elias MD (retired), my colleague in the Society for Participatory Medicine, says that when he repeatedly asked his employer (a large medical center in Maine) to grant patients access to all their chart data, every time the management said they couldn’t, because the data is such poor quality.

Peter loves wisecracks and perverse aphorisms; his email signature says “The chief cause of problems is solutions.” We cannot assess solutions to system problems without remembering why the systems were needed in the first place: pages of crap like that were of no use in improving healthcare, or even in knowing what was going on nationwide. (Imagine being an E.R. doctor or someone providing coverage for a doc on vacation, and having to practice medicine based on that sheet.)

P.S. I bet that ENT’s experience is that patients have no clue what’s going on.

For healthcare to achieve its potential, the information gathered by smart clinicians must get digitized, same as all the other information in every other industry in the world. If the systems to do that are bad, we should insist that the vendors fix them – not return to scribbles.

e-Patient Dave deBronkart is a cancer survivor, noted for his activist work in promoting access to health care data. This post originally appeared on his blog here.

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Rattehalli SudeshRobert BowmanDave deBronkart Recent comment authors
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Rattehalli Sudesh
Rattehalli Sudesh

Sure, the old clinic note was not great. But the issue with the EMR now is not the actual chart, but how we are are required to chart a visit. If my EMR allowed me to chart electronically only what was seen and done in the office, without needing to reach a certain number of checks to reach a particular ‘level of exam’, my aggravation would be much lesser. And my EMR chart would look a lot neater as well.

Robert Bowman

Here is what we got in the US in the decade after HITECH to MACRA to PCMH to Value Based 1. Declines in primary care visits with worse to come as practices pay more and more and get less – the opposite of value and clearly a move toward higher costs and lesser quality 2. Declines in primary care visits for the elderly in particular (pointing to CMS and disruptive innovations) 3. A decline from 38 billion to invest in primary care where most needed to 30 billion after subtracting the added costs of delivery (about $30,000 to $50,000 more… Read more »

Dave deBronkart

Thanks for the cross-post! I hope people will also check the comments on the original post, where I’m collecting notes people have sent regarding harm or danger from such things.