The EHR Continues

In a New Yorker piece by Gawande he bemoans the EHR he is forced to use. We have been bemoaning this for the past decade. EHRs are not easy, they take away from patient interaction, often alienate the patient from the physician and cost more. Furthermore they really are no patient records but institutional and fail to be portable. Other than that I guess they are fine. They were mandated by the Obama Administration as part of the ACA. As anticipated being mandated by a physician with a strong political bent, they are classic "we know what's best" designs.

As the author notes:

“They’re long, they’re deficient, they’re redundant,” she said. “Now I come to look at a patient, I pull up the problem list, and it means nothing. I have to go read through their past notes, especially if I’m doing urgent care,” where she’s usually meeting someone for the first time. And piecing together what’s important about the patient’s history is at times actually harder than when she had to leaf through a sheaf of paper records. Doctors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information—an entire two-page imaging report, say—rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters. Multiply that by twenty-some patients a day, and you can see Sadoughi’s problem. The software “has created this massive monster of incomprehensibility,” she said, her voice rising. Before she even sets eyes upon a patient, she is already squeezed for time. And at each step along the way the complexity mounts.

In fact one spends more time trying to game the system and failing to diagnose the patient. The problem gets worse since all too often the software designers look upon the physicians as dolts. Dumb old folks they have to train like old dogs.

I suspect as we noted a decade ago that this will not change. Yes we have all this fancy technology but we practice medicine not programming. Worse yet the support and training staff do not understand their customer in many cases and worse yet they care less.