EMRs: Pre-clinical vs. Clinical Med Student Opinions

My Pre-clinical Med Student Perspective:

Why is this a debate?  Why is it even an issue?  Why wouldn’t all medical records be electronic already?  Are you telling me we live in an age where I can do all my banking online, even depositing checks without leaving my bed – and yet there are still hospitals where orders are written manually, in handwriting so terrible it causes thousands of deaths each year?

The only logical explanations for this I can dream up are 1) healthcare bureaucracy is about as efficient and timely as an asthmatic snail, and 2) there’s a lot of attendings who feel that EMRs are “too confusing” or “easily hacked”.

Since I can’t do a damned thing about #1, I’m going to argue point #2.

First, the danger of “computer hacking” is vastly overplayed.  We’ve got to at least try to keep it in perspective: I can don my short white coat and stethoscope and stroll into any teaching hospital in America and simply open a paper chart.  I can read it completely without anyone questioning my presence in the slightest – they’re used to random med students they don’t recognize.

So “hacking” into completely non-electronic, 100% paper charts is – like 90% of success in life – simply a matter of walking confidently and wearing nice clothes.  And as xkcd reminds us, you can just buy lab coats.

At least hacking into EMRs will require some relative work.

As far as EMRs being “too confusing”, though – I have to admit, I have some sympathy for these guys.  They’re usually the same attendings you see concentrating like hawks on their keyboard as they type each e-mail letter. by. single. letter.

But as frustrating as that is to watch, I just have to remind myself that touch-typing wasn’t required for their generation.  It was a new, fancy thing after their time that was no doubt both really popular and really annoying.

It’d be like if I became an attending and the standard of care turned into… I don’t know… rapidly texting HPIs (12 year olds would fall over laughing at my texting speed), or…  other popular things I don’t understand.  (Skrillex.  Twilight.  Drop-crotch pants.)

Unfortunately, EMRs have to be implemented sometime, and there’s always going to be an older generation who isn’t used to working with them.  And they’re always going to complain – I mean, I sure as hell would – so it’s not a valid argument.

In short:  EMRs are logically the next step in healthcare and will benefit practically everyone once they get used to using them.  Forever and ever, amen.

My 3rd Year Medical Student Perspective:

GOD HELP ME, IF I GET ONE MORE ALERT OUT OF THIS COMPUTER I’M GONNA RIP OUT EVERY USB CORD IN ITS BODY AND USE THEM TO STRANGLE ITS SMUG-LOOKING SCREEN TO DEATH.

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8 thoughts on “EMRs: Pre-clinical vs. Clinical Med Student Opinions

  1. Sometimes it’s not being a dinosaur, sometimes it’s purely cost. My dad has a small independent practice that’s been going since 1982. If they switched to EMRs, not only would they have to pay a huge amount of money to get it set up and running, but they’d also have to pay 10 new administrative staff to input records all the way back to 1982. EMRs aren’t a convert-as-you-go thing, where all new patients after 2011 for example get EMRs. It’s required to be an all-or-none thing, and he just can’t afford to input every record for every patient for the last 30 years. He’s going to retire and close the practice if EMRs are mandated.

    • Yes, but you still get a good amount of federal money for converting, correct? Not that he in any way should feel obligated (it’s his private practice, he should do what he wants) – but at the in-process-of-converting-to-EMR clinics I’ve been to, they said they were only doing it to get the federal bonus money for it. Not sure if it covered the admittedly huge cost of converting, but they seemed pretty certain it was working out in their favor financially.

  2. Anecdotal objection to EMR: I went to an osteopath to see if anything could be done for my sternal pain. This was bone pain (yes, I can feel the difference), around the joint between my right ribs and sternum. The student who was entering my information into the laptop that served as my chart ran through a whole list of weird questions that I didn’t think would be super relevant for my young, female self… how many heart attacks? pacemaker? and the like. Then the attending came in and redid the whole damn thing, grumbling all the while. He was relatively young and computer savvy (a mac dude), but hated every EMR system he touched. He showed me one of the starting screens, and there was simply no box to check for “sternal pain.” The nearest choice, which the student reasonably clicked, was chest pain. And that predetermined the next wasted five minutes of questions and attending redos.

    Point: I’m pretty sure all EMR systems will be limited in their ability to describe and record the whole gamut of physical malfunctions and treatments that doctors use, no matter how well-designed. As a patient I’d rather my dr have the autonomy to describe what I describe. And hreat it. And record doing so. I mean, is sternal pain not a thing? Am I the only one?

    Besides, EMRs make it easier for insurance companies to screw us over. But that’s a different rant.

    I always love your blog, apotential. I hope you keep finding time to update in what must be a crazy schedule.

  3. My favorite/least favourite part about EMRs is rotating to every different hospital/clinic site, where each has a different program. This would be lovely except they don’t interact and there are no similarities. So, you spend at least a few days deciphering each wherever you go. Plus, like you showed, the complicating of simple problems.
    I have worked with one good EMR and a bunch of poorly organized or executed programs. No matter what, it is chaos when they go down. People who aren’t used to using paper anymore freak out when they have to use paper.
    But, I have to say they are useful and valuable and people are way too paranoid about the whole hacker thing (but, I can be pretty naive). I am a big EMR fan. Despite the annoying pop-ups and alerts.

  4. I’m not entirely sure how I feel about EMRs as a patient. At first glance I’d agree with your pre-clinical perspective, but it does create a bit of a hassle. My old enough to retire GP uses good old fashioned paper records, but my fairly young neurologist uses EMRs. For the most part the EMR seems to work out fairly well, though every now and then an appointment with the neuro is suddenly interrupted with an exasperated sigh and frantic, frustrated clicking on the mouse and switching over to a notepad so she could stay within the scheduled time and fix it later. My neuro faxes copies of all notes she makes to my GP immediately after my appointments, and it got a little confusing the last time I saw my GP because of some of the completely irrelevant information my neuro had to put into the notes.

    I don’t know if its just me, but there is something a bit more comforting about having a paper file. The first time I saw an EMR program being used I immediately starting getting mental images of error messages (program not responding, shutting down! ahhh!), then started thinking about that *ugh* symptom checker thing on webmd and all the problems that come up with that thing just trying to put in symptoms.

    Given how much more typing the current generation does compared to handwriting though, EMRs can be a good thing. It’s shocking how many college students can type out a perfectly readable paper, but can’t take legible hand-written notes to save their life. It’ll be interesting to see how the rates of injuries and deaths caused by misread charts change once we have more younger doctors working in hospitals and clinics that use paper charts (though I suspect it’s mainly clinics now that haven’t switched over yet).

    • This is 100% anecdotal, but I don’t think that younger doctors going into hospitals with paper charts will lead to increased medical errors due to poorer handwriting than prior generations. The handwriting of every resident and attending in my current, paper-chart utilizing hospital is absolutely atrocious compared to that of the med students. In fact, my current attending keeps telling us that we “will never be good physicians if we continue to write so well! Your handwriting must be illegible if you want to succeed!”. Seriously.

      Of course he meant it jokingly in regards to the succeeding part, but it is true that there are no other legible notes in the charts. I, for one, have to focus extra-hard on writing by hand since I do nearly everything on computer, including a different EMR at every single hospital/rotation I’ve been on, so it’s either going to be legible or just not done (unfortunately, doing the notes are required for that little thing called passing and graduating, so, legibility it is!).

      As a side note, the extra fun places are those with mixed paper and EMR charts. Talk about a total mess — anything can hide anywhere! My current hospital has paper charts on the inpatient ward, plus one EMR for the wards, a separate EMR for outpatient, and other versions of the EMR for particular departments. Everything for every patient is a total wild goose chase; we usually manage to track down all the info we wanted at admission around the time of discharge…or, you know, never.

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