Authors

  • Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Comments

Mitch Keamy

brilliant.

Chris

I spent 4 hours yesterday in a session devoted to training on our new EMR. I have several problems with this. 1) The longer I sat there, the more it felt like the whole point of the software was not optimizing clinical care, but rather optimizing documentation for the purposes of billing and compliance with gov't mandates. 2) Even Epic admits they're at least a decade away from the kind of interconnectivity from hospital-to-hospital that is the selling point behind all this anyway. 3) the whole thing seems to be designed to shift clerical work from the lowest-paid person in the hospital (the $8/hr clerk) to the second-highest (the physician; the highest-paid, of course, being the CEO and 17 executive VPs). Why on earth should I have to figure out all the stupid clicks, buttons, and protocols for ordering an Xray? Will getting rid of all the clerks reall save that much money? What is the REAL movement going on behind all this?

Carolyn Kay

That may be true for your generation, Prof. O'Connor, but not so much for those coming through medical school now. The texting and "tweeting" generation is much more used to typing what you are used to penning.

As to Chris's question about what's really going on here, it's two things:

1. Lotsa taxpayer dough going to the IT folks who supported Obama early and often, and

2. By passing a bill on this, the administration can claim they've "reformed" the health care system, without ever addressing what really needs to change--insurance company administrative costs and profits.

Carolyn Kay
MakeThemAccountable.com

Kirk Parker

Carolyn,

Prof. O'Connor's point remains regardless of the method used to enter free-form text.

Caro

Kirk,

Is it your position that today's texters, who almost never pick up a pen, write more carefully when they pick up a pen?

Carolyn Kay
MakeThemAccountable.com

Mike O'Connor

Carolyn: The pen requires its operator to distill a mountain of information down into a concise and coherent story. The cut-and-paste function of the computer tends to generate replication of huge amounts of information, and almost no higher level synthesis. This synthesis is critical to helping caregivers understand what is happening with a patient. One of the differences between trainees and experienced practitioners is that experienced practitioners can tell a very complex story very concisely, and the way they tell the story is very informative to other practitioners. The Mad-Lib nature of many EMR entries is the antithesis of this. It's not that the EMR obstructs this, it's that it doesn't cultivate it.

Thomas Goldman

Very interesting to know about shadow charts. Thanks for the info.

TG

Allscripts

There are extremely powerful applications of EMR, for example in trauma centers and ICU where decision support systems can write default orders that are based on lab and biometric data. For example, Intermountain Health Systems about 15 years ago did a study that accidentally showed how powerful EMR can be when used correctly.

pain management emr

Yeah. You cannot tell that a system is not good until you try it.

-nj

milton

This synthesis is critical to helping caregivers understand what is happening with a patient. One of the differences between trainees and experienced practitioners is that experienced practitioners can tell a very complex story very concisely, and the way they tell the story is very informative to other practitioners.
This is very nice to read ...i like this artcle very much...thanks for this beautiful information....
Matrimonial
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jessi

Nice post about EMR.
EMR systems can be a complex set of connected systems with significant data collection points or it can be a simple system that collects basic data needed to record and associate health information with a specific patient.
Thanks.

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