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.

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

Great minds and politics seems to be incompatible these days.

Greatness has migrated down to the wallet organ...

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

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

Thanks for your permission. Here is my link:
http://acountrydoctorreads....

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.

"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

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.

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.

While your doctors many be collecting information from you with their undivided attention, I wonder how long it is retained and if it is accurately recorded.

Doctors used to walk into the exam room holding my chart. They made notes in the chart during an office visit. Now the notes are made electronically. I just don't see the diference between making making notes electronically and on paper.

the medical record hasbeen pretty much destroyed with ehr's. it has tampered with the MD note so much that it lacks the information necessary to undersatnd the consult.

I don't know how to evaluate your statement.

I think a medical record is much more than an MD note. It is the pathology report (and the actual scans or xrays). It is the surgical reports. it is the test results. It is a record of prescription and of treatments.

Is the only purpose of a medical record to transmit information regarding a consult?

the purpose of a medical record is to make sense of the data, besides storing scans and prescriptions. Any MD should be able to read another docs notes and undrstand what occurred during the evaluation. That has been completely undermined with EHR's.

I've seen a huge difference. I never saw the top of my doctor's head before EHR. Now it's all I see. I'm jealous or her laptop--it gets way more attention than I can ever hope for now.

"I just don't see the diference between making making notes electronically and on paper."

Again, I have no problems with electronic notes. Just don't make your notes while pretending to listen to me. It is impossible to do both.

You have to chart regardless. I couldn't possibly remember everything my patients tell me otherwise. I have to look at a piece of paper to write or look at a computer. Some doctors make both look like they are disinterested, so I think that some is personal communication skills. I also wonder if you hate your EHR if that will show in how your use the interface.

"You have to chart regardless. I couldn't possibly remember everything my patients tell me otherwise"

There is an ocean of a difference between writing on a piece of paper and charting in an EHR. You will not remember a thing your patient says for every minute you chart in a computer. For me that is unacceptable.

Now if they made my appointments longer, I may not be so averse to it. So far I have not seen that. It is the same amount of time as before, except split between you and a computer and who knows what next.

I actually write my notes on paper and then chart later, however, my point is that I have experienced clinicians who are able to chart on the computer and it didn't seem to affect the experience.

I also wonder if some of the angst over the use of EHRs is generational.

Generational in the same way as texting while driving is generational?

I wasn't aware that texting while driving is generational. I think that is related to a lack of anything resembling common sense....

But texting while doctoring . . .

"I also wonder if some of the angst over the use of EHRs is generational."

Nope....In fact I find people who gush over EHRs are usually the unsophisticated electronic types who know nothing about how computers work. Ask any physician who can code and they will tell you the current EHRs are simply pathetic. As I understand, hospitals are incentivized to use them. When you have to incentivize a "great" product, then it ain't that great.

I wonder to, although I am 47 and not the most tech savvy person around.

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.

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.

I believe I mentioned in my post that I still take notes by hand in the room, so your point about the computer interfering doesn't even apply to me. My EHR helps me figure out how to prep best for my patient (i.e. having all of her information) and help me integrate her care afterwards. I fail to see how that is bad.

I am referring to your pediatrician and other providers who define success from their view point.

It might matter that 99% of pediatrician's patients are healthy. Generally not a very sick population requiring a whole lot.

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.

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).

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.

I use Epic

As a patient who is very familiar with EPIC I think it's quite gainful. I love the way tons of scripts pop up and allow the doctor to choose (prescriptions I fear my paper charter docs may not even be familiar with). My doctors can share the information which helps with their ability to dx because we know patients often leave out vital clues during different visits. Realizing the very sharing of information is the strength and weakness of the whole conversation because we know the sharing is a strength for the patient, but from a libertarian standpoint it's platform for utopian governmental interference...and we know a segment of doctors prefer the privacy of the paper records (for various reasons...some good for the patient and some rather sketchy).

But....really? Isn't the conversation over? It's here to stay.....the only thing left to discuss would be appear to be how to keep the government out of our records....but how is that going to be possible with so many doctors being compensated by the government and so many patients desiring socialized medicine....groan!:) We all have our preferences.

You use EPIC? And you don't have check boxes?? I am on EPIC and it's lousy with check boxes, ones that you need to check twice so they stay checked.

"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.

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.

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!