EMR and Quality of Care
My consultancy does a good of bit of work with healthcare providers, with one of those services being EMR software selection and deployment management. From a technological, flexibility, and efficiency standpoint there is no doubt that EMR is a good thing. Yet I personally still harbor some misgivings about the transition to EMR. These misgivings have nothing to do with the technology or reasoning behind it, or the ravings about privacy and conspiracies, but rather how that technology forces certain changes in the way a physician interacts with their patient. In this day and age where a physician has a turn rate of at most 15 minutes per patient we are already in a scenario where the notion of a comprehensive patient review is out of the question. In fact this is one of the arguments for EMR, the ability to quickly and efficiently have patient histories available at your fingertips in a more meaningful way than charts can provide. Couple that with EMR's capabilities of adding a layer of intelligence to that information and you have a powerful tool indeed. So what's the problem you ask? Good question. When seeing a patient a EMR system requires the physician to constantly be taking digital notes (or checking off a symptom list, etc.) in real-time. To do this their attention must be visually focused on their laptop/tablet instead of the patient. My concern with this is that there are many visual cues patients provide that assist a physician with diagnosis outside of what they are saying verbally. These cues can lead a physician to ask new questions, and think in new directions, that simply will not be asked if those cues aren't seen by the physician. A simplistic example, Macho Man patient says that his pain isn't too bad, his face tells a completely different story. A more complex example, Aunt Judy says she's been getting some light tingling in left arm, but there's a also a slight droop to her eyelid that Aunt Judy doesn't notice...and the physician may not either if his/her head is down staring at the screen the majority of the time. So the question becomes, if the patient turn rate stays the same does the extra information provided across a patients history via EMR outweigh the deterioration in the patient/physician relationship and its impact on diagnosis? It's not that we are asking doctors to do more in the same amount of time if they use EMR. It's the fact that we are asking them to squeeze activities that they once would have done outside of the patient room into the time when they are in front of the patient. Make no mistake, capturing information the patient provides in real-time is far more accurate than writing it up post-visit, but it also means the physician is more likely to miss non-verbal information from the patient. Is the tradeoff worth it? I have no idea at this point, but that's why I still have reservations. Your thoughts?
Matt Ridings - @techguerilla
