Tuesday, June 19, 2012

The EHR Conundrum

I have written extensively on the EHR, electronic health record conundrum, over the past few years but the best description is given in a picture by a patient in this weeks JAMA.

The author states:

No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message. When he saw the drawing, the physician wrote a caption for it: “The economic stimulus bill has directed $20 billion to health care information technology, largely funding electronic medical record incentives. I wonder how much this technology will really cost?”

It is really worth a view of the picture. I have seen this in various modes:

1. A good friend and superb clinician well over 40 can now be seen asking questions while typing on his screen.

2. A dermatologist friend hired an additional staff person to create her records.

3. A group of residents spend their time looking at screens rather than going to patients.

4. A gerontologist scans his patients from the nurses station, never really looking in to even see if they are alive at a nursing home.

Osler would spin over in his grave. The culture of medicine is being lost. Once we actually looked at the urine and could even identify a disorder by its smell. That is unheard of today. One even uses an electronic stethoscope to record heart beats and use AI technology to seek out beat abnormalities.

That, I fear, is the risk with the EHR.