From a loyal reader:
"I am a medical provider at a health clinic that is in the process of implementing an Electronic Medical Record (EMR) system. For those that are not familiar, an EMR is supposed to bring a lot of benefits to a health clinic. One of the most commonly referenced is to improve the quality of care provided. We had our "Go Live" last week in which we were supposed to have all our paper systems disappear into the virtual world. We have been told by many clinics that this process will be quite painful for about 6 weeks, but then we will begin to see the light at the end of the long tunnel and realize how much easier things have become.
"I am going to stay positive and try and believe the "experts", but I can honestly say that these past two weeks have left me coming home each night feeling as though I provided anything but quality care. My eye contact with patients has dramatically decreased- to the point that if it is my first time meeting the patient and I need to finish the chart at the end of the day, I often have trouble remembering what the they looked like! When I expressed this shocking concern with the IT folks, I was told that there is a file in the EMR that will capture a picture of the patient!
"The most challenging part of adding an EMR into the clinic has not been making sure everyone has been trained to find each and every pull down menu or move between screens, more so it has been the complete dissolution of the personality that surrounds each and every patient visit. One of my favorite things of being a medical provider is not the science, not figuring out what medicine fits with what diagnosis, reviewing labs or even seeing success when patients implement changes that improve their overall health.
"What keeps me fulfilled is the so called "psychosocial" part of each and every visit. Finding out what
patients do for work, how many hours they work, how many kids do they
have, do they live with them, how are the kids doing, what about their
parents, who do they live with at home, what financial stress may they
be under, are they in a supportive relationship, are they in contact
with their ex-partner, how do they sleep at night, what keeps them up,
do they wake up tired, when were they happiest? This is the most
important part of any medical visit (well, maybe not the visits in the
emergency room) and the place where more can be accomplished to improve
patients overall health than any medication or ICD 9 code.
"As I keep pushing forward and trying to stay positive, I am struggling with how this information is going to be obtained and captured in the EMR. I am struggling with how not to turn into a machine like the computers that are now located in each exam room. Until then, the psychosocial history will consist of the one and only question that is now captured in a checkbox form- "Type of Patient Insurance- Uninsured, Medicare, Medicaid, Private". I am trying to be excited about the fact that instead of knowing that many of the diabetic patients seen at the clinic are not at goal with their numbers- I will now be able to run a report to access this information. A report that is probably not going to help the patient afford their medicine, get their kids in a more supportive school, get a better job and, most of all, challenge all these systems that are in place to hold them back."
(Picture courtesy of Flickr.com user oldboy)
ADDENDUM: Welcome Grand Rounds visitors. The
submission for this week's Grand Rounds was from a loyal reader whose
clinic just implemented a medical record system. Meanwhile in other
happenings on this blog, we're doing one multi-part series on Neglected
Diseases world-wide (yesterday's was on the Buruli ulcer) and another series deconstructing Lauri Garret's
influential Foreign Affairs article arguing that treating HIV across
the world may not necessarily be the best use of resources to aid people in developing countries. Feel free to catch up on our daily musings on indigent health care, New Orleans, and the such.
On other business, we'd like to thank to Jenny Prokopy, founder and editrix of
chronicbabe.com - a site for young women with chronic illness who strive to live
well in spite of health-related limitations...to be babes! - for listing us and putting together this week's edition.
WOW!! i see your perspective, but on my end- the back office side of things, the EMR has helped me significantly- reducing my workload and providing a checks and balancing sytem..Now.. I wont lose charts.... wont have to bothe physicians about signatures....can scan and send medical records and the list continues..............
Posted by: Danielle | March 05, 2008 at 12:52 PM