A Doc Warns of ‘Magical Thinking’ on Health IT

Healthcare IT and EMRs tend to be viewed by many as a magic bullet - something that can be thrown into the healthcare setting that will resolve many of the problems we currently face. This is an interesting blog posting from the Wall Street Journal Health Blog and has some thoughtful comments.

“There’s this incredible magical thinking about health-care IT,” Jack Cochran said. “Once you put it in, health care will be saved.” Cochran is an M.D. who runs the national umbrella organization for groups of Kaiser docs, and he was a practicing plastic surgeon for years, so he’s seen his fair share of health-care IT implementations. The subject came up this week when he dropped by the Health Blog’s office. “It is a disruptive technology,” he said. “When you put it in, it slows you down.” A Doc Warns of ‘Magical Thinking’ on Health IT - Health Blog - WSJ.

It is logical that IT will be disruptive and will slow you down when implemented, however this is not always the case and many physicians experience an improvement in productivity in specific areas after the initial bugs have been worked out.

Have you experienced a slow-down with your EMR? When did you return to normal productivity levels? Have you increased your speed beyond the time that you worked with paper records?

Add your comments by clicking on the 'Comments' link below.

Comments

[Margaret Tromp]

Interesting article. We had a very rocky implementation of our EMR, there was definitely a lot of "shock factor." We have been using it for three years now, and it is just in the past 6 months that I have really started to see the benefit. I think we need to be clear in what we mean by "slowing us down." It still takes me much longer to get the information into the chart than it did with paper. I don't think it will ever be faster than paper, because with an EMR, you have to think about which field you are going to enter the info into, or choose various preset choices off a menu. The time savings are in getting the info out of the EMR, either for an individual patient or for the practice as a whole. I can now immediately see when my patient's last mammogram was, for example, or within a minute, find out how many of my patients haven't had a pap smear in the last 5 years.
Overall, my speed per patients is not any faster, in that I book my appointments for the same length of time as before. However, I am not booked as far ahead as before, and I am wondering if I am starting to see some benefit there. My EMR tells me tests and interventions that patients are due for, so I might be doing more for the patients at each visit, and then saving on follow-up visitis.

[Terry Unger]

We have been using an EMR in our rural family practice for almost 2 years now, and I would say it is definitely slower than paper. I can type faster than I write, but I still cannot come close to the speed of working with paper charts. Information is easily lost in fields that are seldom used, and I miss the paper chart highlights, diagrams, sticky tabs and the ability to look at several pages or even two charts at once. Continuity suffers and care is more episodic in nature, since we really only view one encounter at a time. It is much easier to skim through the last 10 encounters in a paper chart. Errors are still frequent, as it is too easy to type notes into the wrong patient and then much harder to correct it. For those of us who are barely keeping our heads above water and turning away too many patients during H1N1 season, the EMR is a frustration with a cost in terms of patient care. So far the EMR has trained the doctors how to work inefficiently. It should be the other way around.

[tracy sullivan]

I find EMR very useful and conducive to patient care. If I work off appt schedule I do not put info in wrong patients chart. The EMR has helped me identify more patients at CV risk and by using a built in customized flow chart I can monitor diabetes/cholesterol/bmi/INRs much more easily. I get info in chart more quickly than previously and my charts were a mess and now very organized and easy to track investigations/consults etc. Also lab tables and graphs are very helpful especially for demonstrating/reviewing patient's current cholest profile/HbA1C's etc. with the patient.

Also when patients want copy of report or lab it is easy to print for them and that saves myself and my secretary time. I also find I have less prescribing errors.

Obviously I love EMR and would recommend it to anyone. My office is a lot calmer and I have been able to accept new patients-relatives and friends of my patients by referral. I also like instant messaging to communicate with secretary and faxing referrals directly from chart. I could go on but I guess that is enough.