A Physician’s Voice

It is one thing for me to describe the limitations of traditional (CCHIT-type) EMRs. After all, I have a vested interest in a hybrid EMR. I have devoted 12 years of my life to developing a type of EMR that reflects the physician’s voice and that offers benefits for workflow and quality of patient care. I could be accused of being biased. I would therefore like to share with you an opinion piece published last week in the New York Times, “The Computer Will See You Now,” in which Dr. Anne Armstrong-Coben, a clinical professor of pediatrics at Columbia, shares her personal experiences with a traditional EMR. This one user has hit the nail on the head when she concludes that “the computer depersonalizes medicine.” Her comments support the conclusions presented in the New England Journal of Medicine article, “Avoiding the Pitfalls of Going Electronic.”

Dr. Armstrong-Coben struggles to keep the computer from interfering with her ability to connect with her patients. “I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me.” She describes a chart produced by her traditional EMR as “a generic outline, screens filled with clicked boxes.” She recognizes that these charts are incapable of capturing the nuances that are so important to high-quality diagnosis and treatment. Dr. Armstrong-Coben suggests that alternatives like a hybrid EMR might be a better solution.

I maintain that the computer is a wonderful tool, but for most users it requires a conscious effort. Dictating an exam or writing on a piece of paper is more intuitive and efficient for most doctors. Computers force physicians to tear themselves away from their patients, shift their focus to a computer screen and interface with a keyboard and mouse. Doing so requires deliberate effort to navigate oftentimes-complex screens containing a myriad of dropdowns, check boxes and text boxes. The computer distracts the physician and dilutes the physician-patient encounter—unless the EMR is designed to allow physicians to practice and document exams as they have always done and are comfortable doing. That is what distinguishes the hybrid EMR from traditional EMRs.

With precision, Dr. Armstrong-Coben has identified the crux of the EMR-adoption problem.

2 thoughts on “A Physician’s Voice

  1. Are you lobbying the administration’s committee? Can you help us out by letting us know who we should contact and how to contact them–maybe in a future blog. Thanks. Dan

  2. Dr. Nichols,

    SRS is involved in lobbying efforts to make sure that voices other than those representing CCHIT and traditional EMRs are heard. We are crafting ways in which you and other like-minded individuals will be able to get the information you need in order to influence the process. The legislation calls for public comment periods once the initial set of standards are released, and we will advise readers when and how to participate. Prior to that, once the appropriate administration officials are identified, we will let you know how to contact them regarding committee membership, etc. The best way to stay informed and receive up-to-date information is to subscribe to Straight Talk.

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