Electronic health records (EHR) have been around since the late sixties, and government regulations now require hospitals and doctor’s offices to implement them or receive a financial penalty. So why does each trip to a healthcare provider still seem like we are reinventing the wheel with the medical file?
To illustrate, let me walk you through my hospital visits this week – the good, the bad, and the ugly. As background, my cancer is treated through two hospital systems, both using the most popular U.S. EHR software (i.e. Epic® and Cerner®), and we visited both this week.
I go into my oncologist’s hospital-based laboratory for a blood draw. They have all my information in their system, including insurance, and review it with me quickly and efficiently (points gained for that). They did forget to confirm that I had a limb restriction (an arm I should not have blood drawn from, which they are supposed to mark with a plastic bracelet per my medical record). But on the positive side, I had a minimal wait and the phlebotomist was smart enough to ask about the limb preference before she drew the blood.
I then went up to the oncologist, got my vitals taken, and meet with Dr. K. My bloodwork wasn’t immediately available in his computer but after exam time, talking, and asking some questions, it finally appears in their system. We talk about my next set of scans and I go back to the chemo room and have my Herceptin and Perjeta infusions over the next two hours or so. All in all, a pretty good EHR day at Middletown Hospital.
Because of my continued nausea, fatigue, and memory problems, I email my radiation oncologist that administered by whole brain radiation (WBR). I don’t call because, well he’s a doctor and I’d like to hear back this week (no offense to Dr. P – he’s just a very busy man). I go into my patient portal messaging and he isn’t listed as a send option (although every other Yale doctor I’ve seen there – even in passing – is listed). Fortunately he has given me his business card previously so I email, and I get a response within 15 minutes.
Dr. P has clearly been faced with working around the EPIC system before. He was concerned about my ongoing symptoms so we agreed to another MRI to check for swelling or any new metastases since my WBR. And he reached out to his assistants and schedulers on email cc to arrange a Thursday MRI and a Friday consult with him.
The following day I receive a barrage of messages from Yale, requiring me to create an account and log into a brand new (to me) “Yale Secure Email Messaging Center.” There isn’t even a link on my patient portal connecting the two sites. I acquiesce and register, and there are copies of the scheduling emails in there. Which I am glad to receive, but also baffled by the idea that I have to now have (and remember) access to something new that is a feature in my patient portal already. I mean, at least give those with the brain tumors a break and call me with the appointment (or put all my doctors in the same patient portal).
Thursday is MRI day back at Yale. That morning I went into my patient portal and filled out the pre-registration document they ask you to complete before you come in, supposedly in order to check all my information and save time for the doctor (HA!). So I dutifully check my medication list, note yet again that some medications have changed (I have done this previously but they were never changed in the “automated” system), verify my demographics, and enter the info.
And Thursday evening when I go in for the MRI, I get a stack of paper to fill out asking me every bit of that same information I’ve already offered online. Not a copy of what I filled out online to check for errors, but a brand new blank copy to fill out yet again. The receptionist, the medical assistant, and the MRI tech all look at the paperwork and ask the occasional question (mostly mispronunciations of medication names). The one thing they forgot to ask? If I have any drug allergies (I do, by the way, to a very common drug – sulfa).
Another constant, computer-driven snafu with my MRI is my power port. A power port is a small access point that can be used to both draw blood, infuse medication, and also to inject contrast dye for CT and MRI scans. I have had this power port for about 3 years, and doing some rough math, it’s been accessed at least 60 times. I carry the registration card with me because although two hospital systems have seen it multiple times and taken photocopies of the card “for the file,” they still ask me every single time in radiology if I am sure I have a power port, and typically refuse to use it if I don’t go and dig it out of my purse. Fortunately, today’s nurse recognized me and took my word that I had a power port (which is both a win and a lose – had I been a different patient who thought they had a power port but didn’t, the results could have been dangerous).
Friday, I’m back to see Dr. P to go over the MRI results. No paperwork to fill out but the same barrage of questions from the gauntlet of receptionist, medical assistant, nurse, and resident on current medications, past surgeries, and even what my diagnosis is, etc. (For the record, I told them I had entered them online and they should be correct). Now I understand that we all want accuracy and since I am there for a brain scan, they may feel more comfortable with a verbal run through. But this happens all. the. time. I could go into the hospital next week for an MRI, treatment, or follow up and I’d have to write “I have stage IV metastatic breast cancer” on the top of the paperwork next to my name and birthday (which is all they seem to remember).
And it isn’t just patients like me that have complaints about the system. Dr. P mentioned to us that a newly acquired hospital in the Yale network, where I had my late January MRI done, hadn’t released the MRI films to the radiologist who read this week’s films (radiologists like to have the last scan for comparison so they can see growth, progress, etc.). So he had to manually get access to the previous scan and report. Apparently planned computer integration and process is not a prerequisite to hospital acquisition.
I’ve heard many physicians say that they spend more time staring at a screen and inputting information than talking and listening to the patient. To Yale’s credit, they seem to have added layers of staffers responsible for entering information into the system to free up the doctor’s time. A medical assistant takes and enters the vitals, a nurse goes over all the medications in use (the ones I’ve already checked and entered electronically the day prior), a resident comes in to review why you’re there and take any initial questions, and then the doctor finally makes his entrance. Of course that doesn’t help the frustrated patient who is repeating herself over and over and over again.
Now in my former professional life I would have written an investigative piece on the drawbacks and regulatory implications of EHRs on hospitals and on patient quality of care. It’s also interesting to see how Meaningful Use has guided the path of EHR integration.
But these days it seems I only have time and energy to keep track of doctor’s appointments, filling out their paperwork, etc. I did dig up a couple of informative articles from trusted sources that delve into the topic further. And I would like to hear your own stories of technology hurting versus helping your healthcare experience in comments, below.
- The History of EHRs: 10 Things to Know
- How EMRs and EHRs Differ: EMR Progress to 100 Percent Electronic Medical Records
- EHR Evolution: Policy and Legislation Forces Changing the EHR