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I have a beef.
Electronic medical records.
Yes, I'll bet many of you, reading those last three words, are feeling your blood pressure rise, your heart rate increase just a little, and the skin under the collar getting hotter.
 At work, we are undergoing a major transition from one electronic medical record (EMR) system to another. This transition encompasses the medical side of our university including podiatry, medicine, and the medical subspecialties on our floor. Just yesterday, while writing this editorial, I spent about eight hours in a class to teach "end-users" how to navigate this particular program.
End-user. Ha!
 I've gone from doctor, to provider, to end-user. I'm not quite sure what I am anymore, but somewhere in there I think I still treat patients and attempt to fight the various diseases that plague them.
To be fair, I won't mention any EMR names. I can tell you that I'm going from one horrifically bad program to another with a much better reputation. As an employee of a larger institution, I have zero say in how our medical records are done, but I can say with confidence that going from what we're using to just about anything else will be an improvement.
For full disclosure, I should tell you that I was trained before EMRs and the world of Meaningful Use, PQRS, SCIP, and all the rest. In residency, I dictated all my office notes, operative reports, and consultations. The only EMR I was exposed to was the Veteran's Affairs system, which, I believe, has changed since I was in residency.
 I can dictate a new full patient history and physical in about 90 seconds, an operative report with multiple procedures in perhaps two minutes, and follow-up notes in about 30 seconds. I LOVE dictation. Nothing is easier or faster, once you become experienced.
I offer this information not to brag, but rather to give you the perspective that no EMR program is going to match up to dictation in speed and convenience. With that in mind, dictation is a dinosaur, a thing of the past, about to go the way of the dodo bird.
Yes, my friends who love dictation, I feel your pain, your agony. I hear you screaming, "NOOOO!!!!" at your computer screen. "Don't die, Dictation! I love you!" I've just shed a single tear on your behalf. It's running down my check just like in those old Keep America Beautiful 1970s PSA commercials. You know the ones – "The Crying Indian". There's a sterotyped Native American man paddling a canoe through polluted river waters. He pulls up onto a dirty beach, faces the camera, and one tear rolls down his heartbroken cheek. Ironically, I've heard the man in the commercial is actually Sicilian.
Ok, sorry. I digress. Just give me a second to wipe off that bitter, salty tear. Ah, dictation...
Back to my rant.
Apparently I'm not the only one with Doctor Dictation Disconnect Disappointment Disorder. A survey by the American College of Physicians asked 411 respondents various questions about their use of EMRs.1 The boiled down, simplistic results are shown in the graphic below from NPR.2 In short...we lose time using EMRs.
 Imagine that? A computer taking up our free time. Really? Shocking news!
Just like the physicians in this study, I've seen a significant increase in the time it takes to chart patient encounters. The prior program my employer used required us to essentially text in all of the information, while the new one has various methods to make charting faster. The problem I see, though, is that all of these programs seem to be geared more for satisfying Meaningful Use and other governmental and billing mandates, rather than making medical care truly better. That's not an indictment of EMRs but rather excessive governmental regulation.
I still have to request medical records from other providers. I still risk repeating labs and tests due to lack of access to other physicians' records. Until we establish universal patient health information access across the many EMR platforms, this technology will never be truly "meaningful."
As an educator, I have one extra difficult twist to this new EMR story: my students. Currently, when a patient comes in for care, they will see one of my students or residents first. The student leaves the room, presents to me, and we then go back in and treat the patient. Students write the notes, send them to me in a HIPPA compliant way, and I cut and paste the notes into my EMR. Cumbersome and very time consuming, I know, but at least my students receive the benefit of my feedback on their notes.
With our new system, my students won't be charting directly into the EMR (which would have been an excellent use of this technology). Instead, I will be doing all the charting. The hard part about all this is that I'm supposed to be charting while in the room with the patient, which is something I've never done before. I like focusing all my attention on the patient, which patients, of course, also like. What will happen with this new system is anyone's guess.
More on my trials and tribulations with electronic medical records in the future. Until then, happy charting, and best wishes.
Oh, and don't worry you dictation lovers out there. All you have to do is start using voice recognition software to dictate straight into your EMR. HA! Yeah right. I'll expect to see rapid voice-to-computer dictation just like I'll expect a Tyrannosaurus Rex to walk by my window.
Best wishes,
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
References
- McDonald CJ, Callaghan FM, Weissman A, et al. Use of Internist's Free Time by Ambulatory Care Electronic Medical Record Systems. JAMA Internal Med. 2014 Nov; 174(11):1860-1863.
- Billings E. How Does the VA's Technology Rate Against Other EMR Vendors? Last accessed 3/20/15.
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