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The ugliness of EMRs

May 8, 2010

I was in our family practice clinic today and couldn’t help but noticing once again that the electronic medical record (EMR) system they use looks like it was designed in the 1980s.  Gray boxes with tiny free text fields and little check boxes.  Unfortunately, the aesthetics are the least infuriating design element.  Why is nothing connected in current EMRs?  The single most important thing that has led to the proliferation and usability of information on the internet is linking.  I can be reading a story in the New York Times and by simply clicking links within the story I’m taken to a dozen different sources giving me more in-depth information  on unfamiliar topics.  In an EMR (at the least the ones I’ve used and I have used close to half a dozen of the most popular) nothing is connected.  You have to have a mental picture of where information is located within the hidden folders of the EMR to find the information you need.  HOW IS THAT USEFUL?!  And the thing that truly baffles me–why are hardware and software companies churning out things like Google Chrome, the iPhone, Wikipedia, YouTube, Android phones, the iPad, Gmail, Facebook* and Twitter but we still have EMR systems that look and act like Windows 95?!?!

Never mind that no patient records are connected or even electronically exchangeable (at least not on any scale to make it useful).  I can access my email, bank accounts, travel information, even my research library, from any computer with an internet connection.  But my patients still have to hand me paper copies of their records from other physicians, which they often forget or are illegible (and remember that it takes time, money, and paper to copy those records).  The drug-seeker I saw today–turns out it would have been useful to know she had a prescription written last week by a physician at an urgent care clinic, then another one at the ER.  It also would have been useful to have notes, treatment plans, and medication orders from the endocrinologist and cardiologist who are treating my patient with poorly controlled diabetes.  I might have been able to review these before I saw him instead of wasting 14 minutes of our 15 minute visit trying to help him remember all his medications and instructions.

The state of medical records in our country is shameful.  It’s not a particularly sexy problem or one that is going to be easily solved.  Conflicting evidence exits regarding implementation of EMR systems and decreased morbidity and mortality.  However, the next generation of physicians have grown up in the digital age.  They have learned to leverage technology to work more efficiently and effectively.  Demand for well-designed EMRs will grow as these young physicians move onto the wards and further into administrative positions.  Maybe that will be the catalyst for change.

I hope not, I don’t think I can wait that long.

*I had to thrown in Facebook.  Not because I think it is terribly useful (their interface is becoming worse over time) but because of it’s popularity and near ubiquity.

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