Electronic Medical Records, Built For Efficiency, Often Backfire

Electronic medical records were supposed to usher in the future of medicine.

Prescriptions would be beamed to the pharmacy. A doctor could call up patients' medical histories anywhere, anytime. Nurses and doctors could easily find patients' old lab results or last X-rays to see what how they're doing. The computer system could warn doctors about dangerous drug combinations before it was too late.

Many of those things are an everyday reality in doctors' offices and hospitals across the country. But a survey of more than 400 internists with experience using electronic medical records, or EMRs, documents what doctors have complained about for years: computerized records chew up a lot of time.

Writing up a patient's visit on the computer can take more time than you might expect. More than 60 percent of the doctors surveyed said that note writing took longer using computerized records than before they were implemented.

One reason: There are all kinds of boxes to check that have more to do with the billing department than the patient.

Overall, the survey found that attending physicians, the doctors in charge of care, lost an average of 48 minutes a day because of EMRs. Doctors in training lost 18 minutes a day.

The results, first released online in September, were published Monday in the latest JAMA Internal Medicine.

"EMRs are like democracy," says Dr. Leora Horwitz, director of the Center for Healthcare Innovation and Delivery Science at NYU Langone Medical Center. "It's the worst form of medical records except for all the others ones." Horwitz, an internist, tells Shots. Her own experience jibes with the survey's findings, "I definitely lose an hour a day, but I wouldn't go back."

What's wrong with electronic records? "There are so many ways they are really bad," she says. "It used to be that as I was I sitting with patients I was writing the notes, and I would be done when they left the room. Now, 100 percent of time I have to stay afterward, and I'm a really fast typist."

Horwitz says the record systems are poorly organized and never seem to reflect the needs of doctors and nurses. There's an enormous amount of time-consuming clicking, scrolling and typing.

The benefits from computerized records outweigh the drawbacks, she says, but that doesn't mean the record systems shouldn't be a lot better.

Entering the data is only half the problem. "The time suck is not just on the doing side, it's also on the receiving side," says Rob Lamberts, an internist in Augusta, Ga.

When a specialist or hospital sends him a report about a patient, it's often so full of useless information related to billing, medical coding and rote checkoffs that Lamberts struggles to find the nuggets he needs. "It's like getting a big box full of packaging material, and there's a thumb drive in it," says Lamberts, who accepts no insurance and is paid a monthly fee by his patients.

Sometimes another doctor's EMR wastes his time by automatically sending a report that he didn't ask for and doesn't need. A recent fax from a vascular specialist who saw one of Lamberts' patients was so laughable, he scanned it and tweeted it.

Lamberts was happy to ignore the fax. At least it told him from the start to that was OK: "The thing I appreciated about this fax was that it was brief."

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