I'm a resident physician. EMRs are simultaneously awesome and awful. Awesome because most of the data and past records on a patient are a click away, just as promised.<p>Awful because they're invariably run by underpowered servers and delivered via laggy-as-hell Citrix windowing to crappy end-clients with smallish monitors.<p>Awful because they are all proprietary silos, and good luck migrating your hospital system off one and onto another. The idea of a portable electronic health record is largely a fiction at this point.<p>Awful because so much of the documentation you have to write has nothing to do with patient care, and more to do with defensive medico-legal CYA, and everything to do with the hospital getting reimbursed at the level it wishes to for each patient seen.<p>Awful because the software is legacy enterprisey garbage with a codebase written in MUMPS (look it up!) or some other esoteric language in the 1980s and carried forward with ongoing encrustation and decay since then. Awful because the UI actively gets in the way of our patient care workflow, and not the other way around. Need to look at lab data while writing progress notes on a patient? Too bad, you can't open both at once! Need to look at lab data or inpatient notes while discharging a patient from the hospital? Too bad, there are two layers of modal dialog boxes related to the discharge blocking access to anything else while you're discharging.<p>I've used the two market-leading big-enterprise EMRs in the US, Epic and Cerner, and they're both like this.<p>I used to write software for a living. The crappiness of even the most expensive EMRs (the ones that will set a big hospital system back a couple hundred million for an initial install, like Epic) completely floors me.
Electronic Medical Record systems, and their non-healthcare counterparts in Enterprise Resource Planning systems, never delivered the cost savings and efficiency they promised because, at the end of the day, they're designed to streamline the billing/finance department, not the rest of the organization. The user interfaces are universally awful because they're designed to 'get finance/billing the information they need' rather than 'streamline the process for practitioners,' and at the end of the day the people buying the system aren't the ones who have to use it.<p>Someone once joked to me that an EMR installation was where you replaced all the people in your billing department with the same number of people, at a higher salary, in your IT department.
I had a client that made an EMR that was built on the concept of disease management. The basic idea was that by giving the doctor the right data and questions to ask, the doctor would help the patient manage their chronic condition and help them not need to come to the office so often. Doctors loved it. Patients loved it. Management didn't buy it because it lowered per patient revenue.
EMR is not dysfunctional because it's EMR; it's dysfunctional because it's enterprise software for the Windows desktop.<p>It's very easy for the HN demographic to forget what it's like to use an "average" Windows machine. Startup and login times in the minutes to tens of minutes, extreme disk latency everywhere, nagging popups to update Java (has happened in my doctors' office more than once) and virus definitions, etc. Cheapass hardware is frustrating by default.<p>A surprising number of network-based Windows line-of-business applications are written with inexcusable naïveté - the application simply doesn't respond while waiting for network/server and a request that gets dropped or whatever will render the entire application inoperable for several minutes (or some other irrationally high timeout, if there even is one) unless you kill and reopen it.<p>Because Windows desktop management is so brittle/difficult/expensive and so many applications don't play well with MSI, updating is a manual process of walking around the practice and waiting for computers to be unoccupied so that you can load the new .exe onto them. In practice this sometimes just doesn't get done.<p>Add on the incredibly poor software quality that comes with lowest-bidder offshore development, zero attention to UX, and very aggressive and well-funded sales teams, and you get roughly the situation we have today.<p>I can't wait for somebody to take this on with a well-written web or Linux application. Even better if it targeted a domain-specific, stripped-down, locked-down Linux distro that could be netbooted by thin clients around the practice and deployed in a high-availability setup inside the firewall.
The worst part of "billing" driven EMR's is that doctors get really good at recording procedures and diagnoses to fit what the insurance companies want to hear, not what the real medical condition is. This has the effect of distorting the patients reality polluting the medical data, rendering it mostly useless or of poor quality for any decent medical research work.<p>You got a throat ache, but that is not payed by the insurance? uhhmm immediate upgrade to a pharyngitis.
There is a great chapter in the book "Hacking Healthcare" that addresses the challenges met with writing software that bests paper. I have linked it below for any software engineers interested in this problem space!<p><a href="https://www.safaribooksonline.com/library/view/hacking-healthcare/9781449309602/ch04.html" rel="nofollow">https://www.safaribooksonline.com/library/view/hacking-healt...</a>
This isn't a problem with EMR. This is a problem with poor UX in the software that the doctors are using. Here's the thing about paper records: they're costly as well. Paper records need to be photocopied, faxed, paged through, sorted, filed, unfiled, etc. God forbid the doctor needs to physically move a wall of patient records, or a disaster in the office. EMR are theoretically just O(1) to access, update, save, and send. Not true with paper records.<p>I obviously don't know the true statistics, but I'd hasten a guess that although EMR costs doctors a few extra minutes per patient but cuts the overhead of maintaining and handling those records by an order of magnitude. If the biggest complaint is information overload (as the article seems to suggest), the whole system could be completely "fixed" with a simple OS X system preferences-style quick search box.
Pre-EMR, I thought most docs dictated their notes on tape that were then transcribed to the medical record by clerks. Why are doctors having to keyboard this stuff now?
I'm a nurse/programmer and working with EMRs are maddening. The problem is the requirement that EMRs are built to protect against every potential thing that could go wrong. As a nurse, I'm spending a minimum of an hour a day clicking boxes and copy & pasting CYA lingo for all of my patients to protect against the 1% scenario.