EMR

Ever have those little things buzzing around in your brain, bothering you. You can’t catch them, because, they are imaginary and you can’t even swat at them because…well, they are imaginary. So this one fine day I made a visit to a friend of mine who was the greatest-ever advocate for the Electronic Medical Records. He would go on and on about the benefits. “Oh,” he would say, “look at all the savings in time management. You can carve out specific times for certain ailments, for follow-ups, for meetings and incorporate all the latest articles and merge them with the patient record as a qualifier for what you are proposing as therapy. I mean,” he was almost deliriously out of breath, ”the benefits are endless!” He would exclaim. Thats when the buzzing got loud.

Happily, over time, he had moved from a DOS based system to a Windows one and now had the latest greatest Windows System 7 installed in his Gigabyte filled humming hardware. The multi-screen filled with beautiful landscapes as displays glowed next to his chair behind the desk. The surface software demon however was one that was “specific” to his specialty and even with the whiff of human passage, it geared up for information, displaying a form to be filled with a blinking cursor prompting the next move. He is an Otolaryngologist by trade and a very good one. So his software was specific to the organs that he dealt with.

His office was, as all physician offices are, littered with journals, copied articles and books; a cascading reverie of knowledge. He sat peering around columns of books at me as I sat on the opposing side. His features were not quite as ecstatic as before, but still jovial. He wasn’t quite as bouncy as before, kind of glued to his comfortable chair. Age maybe had allowed the tug of gravity to play a larger role in his life, I wouldn’t tell. But that joy of life he once had, had dissipated some over the past few years.

“So how’s it going?” I asked.

“Good.” He replied flatly and without further elaboration.

And then the floodgates of bottled frustration opened.

“You know this damn thing.” He pointed to the computer, “I spend ten minutes with the patient and then I have to spend twenty on this nonsense. I have to make sure that all the appropriate “Ts” are crossed. That damn default always is so easy, it populates all the lines perfectly, but then one can miss important information. My typing skills are two finger typing and it takes quite a long time to enter the data. I then have to look over at the end of the day over all the charts and re-review them for errors before I electronically sign off on them. So much for expediency! I spend more time with my $60,000 computer mistress then with the patient’s I want to help.” His exasperation filtered out. He continued, “I used to finish work and head home around 7PM, now I am stuck here till 9PM looking over for potential mistakes.”

“But, I thought you loved this EMR stuff?” I inquired.

“I guess, I loved the idea of it.” He was solemn.

“What about the Dictation Software?” I asked.

“Oh that. Well that is another story. All I can say is that there, their and they’re are all the same to a software and can create a bigger mess to untangle late at night.” I guessed he had already played around with it.

There was a moment of awkward silence as if I, the guest, had overstepped the fragile bounds.

“You know this very nice kid who had gotten in the field of ENT five years ago got himself in hot water somehow and the Medical Board revoked his license because he had clicked the default button that had populated the record and in there was a GYN examination that he of course would not have done. The Board decreed that his records were incomplete and fraudulent!" he said with just a touch of a sweat-bead on his brow,  "Now that scares the bejeekus out of me.” He said, his hands now wringing the sweat out of the imaginary ball of clothing. “Unfortunately he... the kid, had used a generic cheap version of the software as his EMR base.” He fell silent for a moment. “But just imagine!” he said, his voice a little louder, “Just imagine the frailty of our profession in all this. Just…Imagine!” His eyes were fixed at me but he was looking at some far off place through me.

We both sat in silence. Mine was stunned at the news and his was stunned at the recall of it all.

“And to further add insult to my injury,” he blurted out, “I had to hire an agency that I have to pay a $1000, for me to get the “meaningful-use” dollars back from Medicare. That agency is one of the approved agencies by the government.” Out of the $60,000 that I spent on this EMR system, $44,000 will be returned to me over three years, provided I can prove to Medicare that the EMR use is appropriate. He fell quiet a moment. “Meanwhile the public is told that we are getting thousands of dollars from the government for free. I am sure everyone else in the field, gets mocked out by patients and business people alike for being on the government dole! What have we gotten ourselves into?” He shrugged his shoulders, “Hell of a way to lose the PR battle in the public/patient court of opinion and income.”

“Hey, cheer up! Look at all the benefits to the patients!” I said trying to help his mood.

“What benefits? My patients are complaining that I spend more time on the computer that answering their questions.” The only benefit I see is the drug-drug interaction for prescribing medications. That I had available to me as software before all this nonsense was promulgated. I could look at my Palm-Pilot and it would answer with the results in a second. Now I have to fill in five different fields before it will give me the answer and at times I will have to override it because my judgment suggests that is what the patient needs, but the software will honk with all its bells and whistles as if I am doing something wrong. I have become fearful of my own decisions and, this is my own business!”

“There has to be silver lining somewhere.” I interjected.

“When you find one let me know.” He replied.

As I was exiting his office to the half-filled waiting room, he pulled me back by my arm. “You know the Insurers are now demanding to see the EMRs before payments.” Now his eyes were wide expecting answers that I could not provide. “Unfortunately, I don’t know the next move in this chess game.” He looked crestfallen for a moment and then regrouped before his eyes met his patients waiting for him. His smile and demeanor changed and once again the patient-physician wonderland of service, integrity, helpfulness, dedication took over. All was well in his world for those brief moments of communications that were to follow, where he would be rewarded by the wellness of his patients.

 The buzzing just gets louder and louder. "Tinnitus," the expert consultants seem to suggest?

I doubt that. Maybe if the EMRs were an invisible background and truly enhanced the operational efficiency of a medical office... then maybe the buzzing would go away.

The only thing reverberating in my head are these words, “See what a scourge is laid upon your fate…”