Blog | Thursday, December 14, 2017

When electronic medical records crash

The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era. The paper medical chart I used during most of my career never crashed. Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed. Although I appear to the patients as a breathing and willing medical practitioner, I might as well be a storefront mannequin who appears lifelike, but cannot function. We cannot access the patients' records, write a prescription or enter a new office visit.

Of course, like any business who faces this crisis, we expect instantaneous rescue from our IT professionals, as if we are their only client and they are permanently stationed in our waiting room just waiting for us to sound the alarm.

This is among one of the most frustrating aspects of EMR for medical professionals. We simply don't have the time or psychic reserve to absorb unexpected loss of computer service. We are not playing computer games (although sometimes it feels as if we are.) We have a live patient facing us as we face a blank screen. It is frustrating and awkward. The patients understand this reality as they undoubtedly have endured similar frustrations in their own lives.

Yes, we resort to writing a note in longhand and scanning it into the EMR later, but this is problematic. First, a scanned document cannot be read by our EMR as this document is not “part of the EMR family.” It can't be tracked, as we do routinely with laboratory and X-ray data. More importantly, I will be offering medical advice without any access to the prior medical record, which may span years. If the patient has a complex, chronic condition with a history of extensive testing and medication changes, moving blindly could lead me into a blind alley or through a trap door.

I propose no solution to all of this. No technological system can perform perfectly. It's another example of our ever increasing reliance and dependency on technology, more than we really need, in my view. I have no choice but to accept EMR in my professional life. But, there are opportunities when we can stand up and push technology back.

Do we really need Alexa to turn on our lights?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.