The Software Will See You Now

David Blumenthal argued that electronic medical records haven’t been widely adopted because they mostly benefit patients, not doctors. Fallows passes along some pointed criticism of that view. Here’s Creed Wait, “a family-practice doctor in Nebraska”:

The saying is, “Build a better mousetrap and the world will beat a path to your door.” The saying is not, “Build a different mousetrap, pay out nineteen billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it.  Then shove the world kicking and screaming against their will through your door.”

So far, doctors have been paid $19B in incentives to buy [Electronic Medical Record systems].  No one had to incentivize the cotton gin.  It was simply a better product. The current EMR system is a mess because the current EMR systems in use by the majority of physicians were written in the Rube Goldberg School of Software Design and work poorly.  There is no ‘asymmetry of benefits’ as proposed by Dr. Blumenthal.  Unless, of course, what he means by this is that only the software companies are benefitting from these federal mandates.

Wait offers a personal example:

One year ago in private practice I could see eighteen patients per day.  A transcriptionist typewrote my notes. These were typically three pages long, concise, complete and extremely useful.  Then our group bought an EMR.

After one year I was seeing fourteen patients a day, my notes were twelve pages long, the vital signs alone required a half page and the notes bordered on being useless.

My reimbursement per visit had increased, my face-to-face time with the patient was shorter, I was doing a poorer job, patients were less satisfied, and I was completely frustrated by trying to build each note out of dozens of pages of drop down menus.

Before implementing an EMR I had approached each patient encounter with an attitude of, “What can we do today to improve your health, happiness and overall satisfaction with life?”  The patient and I would have a meaningful conversation about the pertinent issues.  Once an EMR was implemented, a subtle change began.  It was so gradual that at first I did not even recognize the poison.  But after a few months I realized that the visit had slowly evolved into, “Just a minute, we need to be sure that we have checked off every box on every screen and we need to be sure that a narrative of some sort has been entered into every required field.”  Then there were realizations like, “Oh, look.  If we add one more point to the Review of Systems then we can raise the billing code one notch.  Hold that thought while I click, ‘wears glasses’ under the ROS field!”

Well, time’s up!  The fields are all now completed and all goals have been met!  Next!

The EMR had become the primary influence in the interview.  The dynamic had changed.  The patient and I were now both in the room to feed the hunger of the software.