When Regina Harrell, physician and assistant professor in the College of Community Health Sciences, enters the scene of a house call, the first thing she does is pick out a spot to kneel on the floor, practically at the feet of her patient.
After some conversation, she pulls out a palm-sized device from her bag and introduces it to her patient as a new toy. The patient puts their fingers on either end and lowers it into their lap. Harrell pulls out her iPhone. The device, relatively new to Harrell, allows for on-the-fly electrocardiograms, which she can receive and download directly onto her phone. After the reading and visit are complete, she closes her bag and leaves, never having touched the bulky laptop she uses for compiling and updating electronic medical records.
Harrell recently found herself on the front page of NPR’s website after writing a column expressing her frustration with electronic medical records, which have abruptly become a part of health care nationwide through federal mandate. Harrell’s column “Why a Patient’s Story Matters More Than a Computer Checklist” was published on Pulse, an online health care magazine, and began generating above-average traffic before it was featured on NPR.
“You have things happen, and you’re frustrated about them … Writing them down can help congeal the thoughts in your head,” she said.
Harrell said the health care industry is currently working to meet standards of care while still working with patients on an individual basis.
“There’s a real challenge in health care to nationally prove that people are meeting standards of safety and quality while also providing appropriate individualized care for each individual person,” Harrell said. “I think that’s the crux of where we’re stuck right now.”
Harrell said electronic medical records (EMRs), which are meant to streamline and connect a patient’s various health care providers, have become polarizing because they often force physicians to choose between detracting from the quality of in- person visits or adding hours of unpaid, frustrating work to their day.
“Every physician has a strong opinion on computerization of the health care system. Some of them love it, some of them hate it, but everyone has a strong opinion,” Harrell said. “They’re asking us to do more and get paid less in a way that’s very unfulfilling … That’s what’s making so many physicians frustrated.”
Brian Wilhite, a physician with Internal Medicine Associates, is currently in transition. He said some aspects of EMRs do help ease the process of retrieving records, but for doctors like him who deal with multiple issues per visit, EMRs can also slow the process down.
“Currently, many of the EMRs are not yet integrated with other systems. So what you get can be dangerous, an incomplete chart,” Wilhite said. “Sometimes no chart is better than an incomplete chart because you can potentially have a chart that can give you a false sense of security of completeness.”
Wilhite said stipends have not realistically compensated for the expenses EMRs have generated. He has opted out of using scribes for cost and confidentiality reasons but has seen negative impacts on efficiency.
“Throughout the training period, I was frustrated with the EMR system, often commenting, ‘But that’s not really important’ or ‘That’s not really how we do it’ or ‘Why don’t they do it this way?,’ as it is obvious that many of the current systems were not developed by physicians. Yet I expect in time this will improve greatly as doctors that are getting burned out and retiring physicians are now occasionally acting as consultants to assist developing EMRs,” Wilhite said.
Ultimately, Wilhite said he would increase the stipend or make EMR transition optional.
“Overall, I do not believe it will make me a better provider, nor do I believe it will be easier, and I can see how mistakes will not be reduced, possibly even increased,” Wilhite said.
Hannah Zahedi, a sophomore who worked at a physician’s office during its EMR transition, said she felt the sentiments of the physicians was generally negative.
“It’s definitely less time with patients, more time in front of the computer,” Zahedi said. “They had good intentions; they had the idea in mind that the patient will be able to access their information online through a secure system. But during the visit, you already have a limited time with the doctor, and that’s decreasing more.”
Zahedi said the system their office used was flawed, displaying access problems and issues with its dictation system. She said the portable computers that ran the system were definitely noticed by patients.
“That puts a divider between you and the patient almost immediately,” Zahedi said.
Some practices, however, are experiencing the boosts in efficiency and effectiveness EMRs are supposed to bring. Kristy Sillay, student medical office assistant at G.I. Associates of West Alabama, said the system has been beneficial to their practice.
In her own job, Sillay said, the systems make it easier for her to deal with patients and their records.
“I can see [what I need]. It’s right there on the computer screen,” she said. “Any nurse can pull up the chart and see what’s going on and take it from there.”
EMRs come in different shapes and sizes, so different physicians often experience different results.
Alex Morris, who has worked in hospitals and private practices in Tuscaloosa and at home, has seen both sides of electronic medical records.
“If you use it with a scribe or do it afterwards, I think it can be a really effective and efficient tool,” Morris said. “It’s when you try to do two things at once [that there are problems].”
At one hospital where he worked, Morris said the system was improperly used and the confusion often resulted in an “electronic paper Hail Mary.” He said the design holds fundamental flaws.
“A lot of times there are loopholes with different patients where things don’t fit into clearly defined categories,” Morris said.
He pointed to the endless string of checkboxes as something that made the systems cumbersome. Harrell, in fact, targets the checkboxes as an example of why EMRs are rapidly becoming a thorn in the side of practicing physicians.
“The checkbox system generates so much computer-speak,” Harrell said.
In one case, she used “home health” to reference a personal call, only to find the system had not been equipped to describe that scenario.
“It made it sound like I took a tube of home health and put it on her leg,” Harrell said. “There wasn’t a way to generate that with the checkbox system.”
The new system, Harrell said, is making it difficult to train new physicians in note taking and causing record size to balloon. She predicts that changes and modifications will be made to the system over time since the market situation currently creates systems with little focus on doctors and their needs.
“The people paying for the system are the hospitals. The people who have to use the systems are the doctors,” Harrell said. “The people who are the end-users are not the buyers.”
In fact, among the people who have contacted Harrell in the wake of her publication have been software companies looking for her insight.
At the house call, Harrell opted not to use the laptop during the visit, since the process of setting up and connecting to the system can be awkward in a living room, but she isn’t convinced technology has to be a barrier. Pulling her iPhone out again, she started scrolling through pictures of her 2-year old son, who she and the patient joke is the doctor in the family.
“Which is okay,” Harrell said. “He’s good medicine.”
