In defense of the EHR

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I know they’re just about as popular to defend as taxes, but I have to say that I absolutely love that I live in the age of electronic health records.

The typical line you get from providers when it comes to EHRs is about how they’re just about THE WORST THING EVER when it comes to patient care. Sure, maybe The Man needs us to use EHRs for billing and coding and a bunch of stuff we really don’t want to bother thinking about, but it’s SO not worth it when it means all we do every day is click click click tiny boxes instead of looking our patients in the eye. Please for the love of God give me back my paper chart!!!!!!!!!!

I respectfully disagree.

Here are some things I ❤ about EHRs:

– I love that I can look up my patient’s records from the ED last night, or last week, or last year, giving me a heads up on what really did or didn’t happen (hey, stories change) and reducing unnecessary duplication of care.

– I love that there’s no paper chart to go missing. No matter what room I’m in, if there’s a computer in there (and there always is) I can get in that chart and do what I need to do. (Unless the printer’s out of paper. And the printer is usually out of paper. This is not the fault of the EHR.)

– I love that I don’t have to struggle to interpret Dr. ShakyHandwriting’s chicken scratch ever again.

– I love that I don’t get loads of grief from my colleagues for my own terrible, shameful, no-good handwriting. Ha.

– I love that I can type out my notes instead of write them by hand. In addition to the aforementioned legibility problem, I type a million times faster than I write with a pen and paper. Not an exaggeration; I’ve clocked it.

– I love that there’s a record of the exact prescription written for each patient, along with a digital trail showing when and where it was sent. No shady business.

– I love that I can send notes and labs and prescriptions and whatever else I want without getting up and fiddling with the stupid, stupid fax machine. In the time that passes as I wait for the fax machine to dial the number, and make that terrible AOL-era dial-up connection sound, and finally FINALLY start transmitting the fax, I can actually feel death approaching. The passage of time becomes just that palpable. And since I dislike reminders of my own mortality, anything that reduces my use of the fax machine is a good thing.

– I love that if I’m taking off-hours call, we have this fancy little iPhone app that creates a magical time-space portal to our ENTIRE EHR, which means I can look up that patient’s chart from bed, at dinner, at the movies, in the potty, WHEREVER. (Yes, I call it a potty. And don’t judge. Big thanks to parenthood for giving me the opportunity to study the tile pattern of restroom walls all over town in painstaking detail while waiting for my offspring to finish her business.)

But I’m not blind. I’m not an ostrich with my head in the sand. I’m not wearing rose colored glasses. I’m really not engaging in any one of the many possible metaphors one could use for ignoring glaring problem areas. Such as:

– Templates. Whoever invented templates, I hereby declare you the enemy of sanity. I can feel my hand cramping into a permanent claw as I strain to center my clicker inside one. tiny. box. after. another. All told I’m guessing at least several hundred (thousand) tiny boxes will be clicked by the time I’ve finished writing one template-based note.

Happily, my hands still look like hands rather than velociraptor appendages because I’m allowed to use words and sentences like a normal literate human being within my clinic’s EHR. But opting out of using templates myself only solves half the problem, because I’m still forced to read other people’s terrible template-based notes, and then guess as to whether the story created from all those little checked boxes is really the story they meant for their note to tell.

– Vulnerable to technology fails. Today, in fact, was a happy little reminder of this particular weakness. Our EHR was down all morning. Semi-organized chaos ensued as we tried to figure out who was here to see which provider without accidentally seeing patients out of order and thereby inciting mutiny among the impatient crowd. I was told this conversation actually happened at the front desk:

“There will be a bit of a wait to be seen, since our computer system is down.”
“Can I schedule an appointment for this afternoon?”
“Well, no, because our system is down.”
“…Um, so, can I schedule an appointment for tomorrow then?”

But this unscheduled journey into the past just reminded me how fantastic having an EHR the rest of the time truly is. My concerns are not deal-breakers, they’re areas for improvement. I mean seriously, in the age of Google, and Siri, and marketing software that somehow places the exact product I was looking at on potterybarn.com last week into a Facebook ad today, you can’t tell me that the tech geniuses driving up rents in Silicon Valley aren’t capable of designing an EHR that allows us to create coherent, accurate notes in a provider-friendly format.

Make it happen, techies.

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