First issue is electronic health records. Worse than insurance companies, this is the main thing that causes frustration, wastes time, and sucks the life out of me.
I have yet to meet a physician who actually likes their EHR. I am not sure why that is except that they virtually all suck.
Ten years ago I used a program called Epic. It was pretty awesome back then. I have no idea what it is like now. Currently, I use Centricity. Epic ten years ago was light years ahead of Centricity now, which should be embarrassing to GE. I really don’t think they care, though.
In the process of job interviewing I have played around with a couple of other programs: EClinicalWorks and NextGen. NextGen is way behind Centricity. Awful. I didn’t think that was possible.
Anyway, here are the top things I need from an EHR:
1. Fewer clicks to get the job done. I don’t know who the hell develops these programs, but they are not using them every day to see tons of patients, I can promise you. It takes me over 200 clicks to navigate a well child visit. Sometimes very common actions are buried in 2 or three layers of clicks. Makes me want to pull my hair out. I could shave 30 minutes off my day, easily.
2. Order time outs. If I order a test and a result does not come back in a week, I should get a notice that it was not completed. This is a safety issue but very few EHR’s think it is important enough to include. I had an IT guy say this sort of thing was not available anywhere. Wrong. Epic had this capability ten years ago. (You other people are robbing physicians and patients of a very powerful tool!)
3. Patient instruction handouts that are brief and to the point. I need a section at the top to free text my instructions. An active medication list. Discontinued medication list. New and changed medications (and which pharmacy they were sent to). Preventive care info (like when the last tetanus booster and mammogram were done). Vital signs from today’s visit. Date of next appointment. Cram this all onto two pages otherwise patients won’t read it. Our last update took the average length of the patient instructions from 3 pages to about 15. What the hell? Who has time to read that kind of crap? Granted, part of this was because of “Meaningful Use” mandates from the government, but that deserves its own special post…
4. A patient portal that meshes well with the EHR. A portal is where patients can get their lab results, copies of imaging reports, send messages to their doctor, etc. Ours goes to a completely different, isolated section of the EHR and is a pain in the butt to use. I cringe when a patient sends a note because it is a ton of work. In fairness, not all portals mesh as badly as Centricity’s does. Really, ideally, the interface would be seamless.
4. A stable system. No crashes. No ghosts or flukes in the system. It is terribly disruptive in the middle of a busy clinic to have to sit on the phone with the help desk for 20-30 minutes only to be told, “It is a known problem and we can’t fix it. We have engaged the vendor for a solution.” That is IT lingo for, “Suck it!” And I do. Because it rarely ever gets fixed.
5. Good grammar. So many of the visit templates that have you click symptoms or exam components put them together using gibberish or terrible sentence structure. “No masses and enlarged prostate.” It should say, “Enlarge prostate, no masses.” Missing punctuation. Stilted syntax. If I really spoke or wrote this way my clinical skills should rightfully be questioned. This infuriates me. I do not pretend to be a master of the English language but there are some basic tenants that should not be ignored.
6. The ability to free text at will. I like for my notes to tell a story. One program does not allow much free texting in the history of present illness section for example. Instead of being able to say, “The patient was riding her horse when she happened upon a paper towel that startled the animal. She was subsequently thrown to the ground and trampled repeatedly.” I would have to say, “The pain in the chest and arms and legs and back and head started on 2 hours ago. The quality is sharp. The severity is 10/10. The duration is constant.” This tells you nothing about the horse or the nature of the accident which is an important detail as it helps to indicate this is likely a serious injury, not to mention the grammar issues (see #5).
7. An easy way to see which preventive care items are due. I want a page that shows me what the last blood work was for a diabetic, when the last eye exam occurred, and if the numbers are all at goal. I want to be able to look further down the list to see when your last PAP was done and if you are due for your shingles vaccine. I do not have time to go searching through the entire frickin’ medical record to find each and every one of these things each office visit.
Bottom line: I want all of these things in ONE package. One program. Not 2 or 3 items. ALL of them.
Why can’t I have this? Physicians are pretty unanimous about what they want. Why can’t a single EHR deliver?
This is my theory:
Early on, groups made decisions about electronic health records based on cost, not quality, thinking incorrectly that they would get to help improve the system. Yet once they were a year or two down the road into an EHR and realized it was awful, it was too late. Switching means the potential of quite a lot of lost data, TONS of work preloading charts. Plus the frustration of learning an entirely new system. Once a company has you by the balls, they know they do not have to provide quality enhancements. All they have to do is make a passable attempt to try to “improve”. Then they can just kick back and reap the rewards in the form of big fat checks.
It is blackmail, essentially.
We let them get away with it, though, so we are all willing accomplices.
I am sick and tired of hearing at interviews, “Well, there is no perfect EHR.” Look we have smart phone apps that do anything imaginable, virtual reality games that are crazy realistic, and we have 3D printers for crying out loud! You cannot tell me that there is no one out there smart enough to make an EHR that is good, that is something to be proud of, that can save the lives of patients and doctors and nurses and ancillary staff.
If you are that person, I will be happy to help you!!! Meanwhile, if you are reading this and really do love your EHR, I would to hear which one you are using and why you like it so much!