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Thomas D Guastavino, MD • 5 years ago

The year is 1990. The federal government has made the decision that everyone needs to switch to cell phones. The government claims that landlines are to inefficient and prone to error which may or may not be true. The only thing everyone can agree upon is that it is much easier for the government to monitor cell phones then landlines. In order to coerce people to switch to cell phones the government first provides bribes, but eventually will fine people for not making the switch. However, in order to get the bribe the users have to follow and document certain guidelines and have to do so within a fixed time frame.
Cell phone carriers rush in provide the phones. With the rush to make the switch, fundamental errors are made such as different carriers working on different frequencies so some phones won't communicate with each other, if you can get a signal at all. Worse still, the market is dictated not by what the users may want or need, but how best to meet the criteria to get the bribe. Phones are made with a 25 digit keyboard so required codes can be entered. Before each call can be made a pop-up question screen appears so that the user can meet the requirements the government has decided are necessary to make the call. 24 years later some users have gone through multiple phones, cursing the day they ever switched from landlines.
Congradulations on finding an EHR you love. I suspect you are the exception rather then the rule.

Margalit Gur-Arie • 5 years ago

This is too good.... Check out the third paragraph here http://www.kevinmd.com/blog...
Great minds and all that... :-)

Thomas D Guastavino, MD • 5 years ago

Great minds and politics seems to be incompatible these days.

Acountrydoctorwrites • 5 years ago

I'd like to quote this on my blog with a link back here or to your website if you have one....

Thomas D Guastavino, MD • 5 years ago

Don't have a website but you are welcome to quote me. Thanks.

iphone12 • 5 years ago

As someone who feels that disclosing my past psych med history has caused me to receive subpar care from doctors that had absolutely nothing to do with my current issues, I find the thought of electronic medical records horrifying. Since I absolutely have no rights as far as I can tell about what gets entered into the system, it will cause me to be very cautious as to what I disclose to future doctors. So the next time physicians wonder why patients aren't being totally honest with them regarding past medical history, the fear of doctors being able to access information that you don't want seen is a major reason.

Chiked • 5 years ago

"My children’s pediatrician moves effortlessly between the computer and my kids and doesn’t seem to make it impersonal at all"

Really? If that works so well, how come all the other health professions aren't dragging computers to the bedside. Went to the dentist last week and my kids had my dentist's undivided attention. The week before then my youngest needed her hearing checked. No EHR there.

Face it doctors lowered the standard years ago and now patients can't even tell there is an elephant in the room. You could have had a band playing in the background and you or your kids still would not have found it impersonal. We are in the era of Walmart medicine

Lisa • 5 years ago

Other health professions use computers. My dentist uses a computerized record. He can down load x rays to the record and keeps treatment records on it. It is not at all distracting and I still have his undivided attention when he is cleaning my teeth (he doesn't use a hygienist). My optometrist also uses a computerized record system. Again it is not distracting. My podiatrist uses an EHR. I like the fact that he dictates his notes while I am listening, because it gives me a chance to make sure we are on the same page. My lymphedema therapist enters histories and notes into an EHR. I don't find it distracting; she would either be entering data into a paper chart or into the computer.

Last time I saw my pcp, he didn't bring his computer into the exam room. I wanted specific information about a test result - he had to leave the room and get his computer. He has brought his computer into the exam room on other visits. I think he is still trying to figure out how integrate it.

My first oncologist used paper charts. He spent a lot of time leafing through my chart to find information. After he retired, I began seeing a younger oncologist in the same practice. She uses an EHR. I notice she doesn't spend much time going through my record to find information. Most of her time with me is spent asking me about any symptoms and on a physical exam. She usually updates the EHR at the end of the visit. It isn't intrusive.

From my point of view as a patient an EHR in the exam room is not a big deal.

Chiked • 5 years ago

There is a big difference between providers using computers and providers using computers while examining or treating a patient. You may find it reassuring but maybe your time isn't that precious. I expect every second of my 15mins in the doctor's office to be spent on ME. Why? Because the human brain cannot yet parallel process. I derive comfort from knowing that every bit of information being collected or given to me is done with their undivided attention.

Jen • 5 years ago

I don't know why other providers are not able to use the computer as effortlessly as my pediatrician. We have been using EHR exclusively for 7 years that might be part of it.

Chiked • 5 years ago

Your success on a computer has little to do with what you feel but how your patients feel. Ask your sick patients (emphasis sick) if it seemed like you were so terrific now that you spent more of their face time on a computer.

Acountrydoctorwrites • 5 years ago

It doesn't sound like your EMR requires structured data entry with all your talk about typing or voice recognition. You don't have checkboxes to describe a patient's symptoms????
Tell us the name of your EMR.

Jen • 5 years ago

I don't know what you mean by check boxes for symptoms, so I guess not. I have check boxes for diagnosis. I do my notes free form (typing or with voice recognition).

Acountrydoctorwrites • 5 years ago

Think Color by Numbers versus painting from the heart. Choose only between crushing and squeezing chest pain. Describe clinical findings by clicking the box that best matches what you see. That is structured data entry, easily searchable compared with free text where doctors can describe size as "plum sized" instead of in centimeters. Imagine writing your memoirs from drop down menus.

buzzkillerjsmith • 5 years ago

"I think to mandate something you need clear tudies to show it saves lives or improves health." Yup.

If you like your EHR you should use it.

Next case.

John C. Key MD • 5 years ago

It's not the EHR that bugs me. It is taking direction from non-medical IT staff that may be nice people but don't understand how our world works. Every couple of months our organization gets an "upgrade" to our EMR which (1)always adds more keystrokes (2) has nothing to do with documenting clinical observations and (3) allows audits of various minor jots-and-tittles of the chart content. I wish our upgrades would make the EHR more doctor-friendly and relevant for patient care.

Now, having to keep one's face glued to the monitor, that's another issue.

Jen • 5 years ago

A lot of the upgrades that I have seen are due to State or Federal metrics that need to be recorded. Some I think are institution specific. My point is be careful what you blame the EHR for and what you blame on non-EHR mandated metrics that you would be forced to capture regardless.

We also get a lot of internal upgrades, but to me the nuisance is in the change. In a day or so it seems just fine. Many of our upgrades are also very useful shortcuts. We have doctors who are so computer savvy that they identify issues and then write code to make it better. When th person writing the code also uses the system it helps a lot!