Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

My Medical Records Apocalypse

Recently, I experienced a medical records apocalypse, the perfect storm in my life. Maybe you've had a similar experience? I'm currently on staff at multiple hospitals in the area outside of Los Angeles – five to be exact. All of these hospitals have converted to electronic medical records systems, and the two busiest ones for me have both recently converted. Between these hospitals and my academic practice at Western University, I have been dealing with so much new technology all at once: my unfortunate medical records apocalypse. This has been a somewhat frustrating situation for someone who was in elementary school when they first started teaching BASIC computer language and computers started taking off. I didn't own a personal computer until I was 21 years-old, and my family's first computer was a Commodore Vic 20 with a dot matrix printer. Needless to say, I'm not the most computer savvy person in the world.

Strike One

You might understand my trepidation, then, this past week when I had to deal with the ins and outs of two hospital electronic medical records systems. My first situation occurred immediately postop after an incision and drainage on a diabetic patient with an abscess. Unfortunately, completing the admitting records for the patient took more time than the actual procedure itself! I did the smartest thing I could: I called the IT help line. They managed to walk me through the process without too much pain. Subsequently, during the next several days in house, I felt increasingly more comfortable with the system. Once I had the hang of it, placing orders and finding labs was easy and quick. Compared with paper charts, this aspect was superior. The system also had the ability to alert the physician regarding potential drug interactions and allergies, possibly the most significant patient safety advance EMRs have to offer. The learning curve was steep, but once accomplished, the system was definitely helpful.

Strike Two

My second interaction with this same system exemplified for me one of the other benefits. The system is downloadable to one's desktop and records can be accessed from remotely, off the hospital campus. This includes not only the patient's labs and insurance information, but also imaging and orders. I spent a good 45 minutes in the IT office to make this happen, and there are still a few glitches to the remote connection, but it's very handy. If I receive a consultation from the hospital and I'm off campus, I can look at all the patient data before seeing the patient. I can also enter orders for the nurses if they call with a question. It's a time saver!

My next interaction occurred with my other hospital's EMR system. Although also available remotely – and via iPAD on the hospital grounds – this system wasn't quite so friendly. Not only did it require multiple logins through different levels of security, but my password repeatedly stopped working. In the middle of seeing a consult, I had to get on the phone with IT and figure out the problem or I would be locked out of the laboratory and imaging data. Unfortunately, this has occurred several times over the past few months – probably because the gods of computers don't like me. Yes, I'm just primitive enough to think there are actually gods of computers, and paranoid enough to think they are wrathful gods !

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How Do YOU Keep Passwords?

My frustrations with this program – I wanted to toss the computer out the nearest window, maybe even stick it in the autoclave and watch it short out – highlighted one of the downsides of technology: the need for passwords. I have a password for everything: personal and work email, work computer, online file storage, 5 hospital EMR systems, ABPS site, ACFAS site, APMA site, CAQH website, clinic EMR, student file site, applicant information site, podiatry logging service for Boards, 4 different journal sites, employee website, PRESENT's podiatry.com, personal and business banks, and many others. I have a different password for each site, and it seems each one wants me to change the password every other day. It's gotten so bad, I have to keep a secret password file so I don't forget (not so secret any more, huh?).

A Few Suggestions...

For those of you less computer savvy than me, here are a few suggestions to help decrease your stress level when dealing with the EMR system that you WILL – yes you WILL – have to deal with soon if you haven't already. With the changes in the Affordable Healthcare Act and the simple march of technology, none of us will be spared.

Retire – if you refuse to accept the idea of converting to and using electronic medical records, then it's time to retire. Your time in clinical medicine is coming to an end…
Take time to learn – assuming you're like most of us and either can't or don't want to retire from medicine, then the best thing you can do is give yourself ample time to learn the EMR system. Don't rush it. Understand that, as you improve, everything will get quicker.
Tutoring – contact whomever your support services are and have them tutor and train you on their system. This will take time (see #2) but will be worth your attention.
Be patient – unlike me, you should be patient with both yourself and the EMR. Some programs are intuitive and easy to use, while others are not.
Be nonviolent – suppress that urge to take the nearest blunt object and beat the mother board out of the computer.

If you accept reality – that computers and electronic medical records are now a fundamental part of life – your job will be that much easier. The future is here, whether we like it or not. Good luck with your next computer experience.