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July 16, 2010 News 1 Comment

Musings on EHR Usings

By now, most of you know I’m a small-town pediatrician in private practice, with an IT department consisting of me. (Not to take anything away from the great job my wonderful EHR VAR support people do, but their 1,000-mile reach has its limitations.)

As the chief cook and bottle recycler, it sometimes amuses me just how challenging this EHR/EMR proposition is, especially when I think of others trying to pull this off who may not be so tech star-struck. I mean, really, how many doctors really care if they’re using pen and paper or mouse and keyboard? From what I see, most of my colleagues just want to provide healthcare help. All that charting stuff is more often seen as a way to get paid than as a real necessity for patient well-being and ongoing care.

I know: in bigger institutions and large practices where patients may see multiple providers, thereby necessitating better legibility and patient care communication, and when you consider data usefulness and sharing, I think most physicians understand that digitization is the way to go. However, I’ll bet that outside of CMIO and geekoids such as me/we, very few really want to be bothered with the technicalities of .NET or MUMPS or SQL or even CCD/CCR. They just want to be docs. And get paid reasonably. And get home sometimes.

We had a recent episode where our EHR kept slowing to a crawl just before freezing completely, again and again and again, over several days. A server reboot would fix it, but it would come back within hours, maybe minutes. My VAR support team finally figured out that a driver needed updating, but we really struggled for a couple of days there.

Then we had one of our touchscreen registration desk kiosks act up. Actually, it turned out to be the flexible, spill- and child-proof keyboard, but there wasn’t much my 1,000-mile VAR could help with on that one. It seems simple now, but the strange effects of the partially-working keyboard caused a diagnostic dilemma for weeks.

The other day I realized I had been using a poorly finished template for many months which necessitated my rewriting pieces of each note that should have been auto-populated. I wasted many seconds every time I had to do that, but during a busy day, who has time to stop and edit a template? Then, by the time the day has beat you into submission, you don’t even remember the little template nuisance when it is overshadowed by the many, much larger issues of the day. You just want to get home. Thus the template remains a constant reminder of the inadequate allotment of 24 hours within which to scramble.

As you can glean, the “Musings” title is befitting, as I’m really not too focused here on any particular issue. Within some of the other roles I juggle, be they doctor-y or HIT-ish, I have very little time for wistful reflection. Maybe that’s part of the point. Maybe that’s what I hope more of the vendor-programmer-developer folks out there will hear.

Being a physician these days isn’t about HIT. It’s still about being a doctor and it is harder than ever. When you sit inside your protected, usually air-conditioned HIT worlds and talk tech-ese with other technophiles, please remember — the people you’re trying to serve, for the most part, couldn’t care less about scripting, unless you’re talking prescripting. Keep it stupid simple … and easy to fix.

From the trenches…

“The most potent muse of all is our own inner child.” – Stephen Nachmonovitch

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

Comments 1
  • Very well Said Dr. Alexander,

    We help physician’s deal with these musings every day. Our goal is to keep it simple so YOU can practice medicine. We are staying very closely tied into all the industry and federal changes to make sure smaller practices don’t get left out in the cold, or more importantly handled incorrectly and set up to fail.

    You are absolutely right about the focus and time issues the physician’s must deal with during an actual office day with all the typical MEDICAL concerns that you are inundated with.

    Interoperability is critical for the portability of our healthcare information, but individual physicians need simple, reliable, long-term systems through vendors that will be here in the future to make sure they can adopt, survive and thrive in the financial, workflow and management arenas and still keep their priority on patient care.

    Understandably a large feat, but definitaly accomplishable with the right help and engagement.

    Thank you for posting that article, it is important for your peers to hear from the trenches what they can expect, both positive (increased efficiency, and all the very strong benefits EMR offers) and the negative or frustrating issues that also accompany this not only in the medical industry, but everywhere IT exists.

    Take care & kudos on your involvement!

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