A good idea gone bad…

If it weren’t so important, I’d let it go. You know how I feel about inflammation.

There is a great farce in the healthcare world that needs more exposure. It’s a terrible problem because it gets in the way of me taking care of you. It inhibits humanism in the practice of Medicine. It inflames me immensely. And I’m tired of quietly toeing the line.

It’s the idea that current-day electronic medical records improve the quality or cost of healthcare. Promoted by cubicle-doctors and wonks in think tanks, this fantasy was held up as the solution to the healthcare crisis. What a mistake!

First a couple caveats: I don’t use the word farce lightly. I looked up the definition and found this phrase: ludicrously improbable situation. No three words better describe the morass created by the forced acceptance of proprietary EMR systems. Second, I am a fan of computers and harbor no doubt that if done right, computers will enhance medical care.

Real doctors, those who actually see patients for a living, not as a hobby, have been writing about problems with EMR systems for years. We write about it because things that inhibit patient care get to the core of our self-esteem.

A review of the current situation is in order. A few notables on current-day EMR:

• EMRs interface poorly with users—doctors. Completing a medical record on an encounter for a common heart rhythm ailment requires me to click more than 25 times. (Fact: All doctors forced to use EMR either decrease the number of patients they see or they spend less face time with each patient.)
• EMRs don’t talk to each other—and in their current form, never will.
• There is not a shred of evidence that they improve real outcomes.
• EMRs function more as a billing invoice than a useful medical record.
• EMR systems are software behemoths that come with such high initial capital costs, that once purchased, a buyer cannot afford to change.
• Doctors are the end-users but not the customers of EMR companies. So our feedback carries little weight. There is no need to offer customer service. Why would there be? An Economics 101 student understands the concept. I get faster service from my cable company.
• EMR companies effectively answer to no one.
• And like many other government-created oligopolies, they have become immensely profitable. Even the NY Times took notice.

In writing these words, I hope to increase awareness of how a good idea has had dreadful results in the real world.

The lack of mainstream media attention to this farce has been surprising. Why would the public sit still and let a few companies get rich with a product that only makes it harder to get humanistic medical care? Why is that when doctors write about intrusive EMR systems, we are seen as greedy gadflies that should just get back to work? Why do my fellow doctors just fall in line and let themselves become data entry clerks?

As an optimist, I hope that a public conversation might help this dire situation. Perhaps recent attempts—by an EMR company–at intimidation of doctors who dare speak out might help spark a useful debate. When a multimillion dollar EMR company intimidates one of the good guys of Medicine, others notice. Influential medical blogger, Doctor Wes Fisher asks us to consider the ethical implications of this muzzling action? “What might a big multi-million dollar EMR company be hiding?” Another influential voice of physicians, Dr Bryan Vartebedian wonders whether “patients have a right to see and understand the EMR that their doctors are using to facilitate their care?” Dr V calls for “a very contagious public conversation” surrounding EHR. He wonders what would happen if influential patient advocates walked clicked in our shoes.

Perhaps it will be hubris–the great mistake of many of the influential–that exposes this farce.

Patients need to understand this is not about doctors. It is about their medical care.

Speak up. Make some noise. Get doctors off the white screen and back to the business of doctoring. Now that would be meaningful.

JMM