Electronic Medical Records – Are We Committed to Making Technology Work for Patients?

I have been working and teaching in the healthcare technology space for the last 15 years and have spent much of that time extolling the virtues of technology. Perhaps history plays a role. The picture of thousands of paper charts lining the walls of the Ambulatory Care Record Room at Kings County Hospital (my first healthcare job) with the letter of the alphabet hanging in order on the walls is seared in my memory, and the relatively pristine medical record areas of today, demonstrate the “improvement.”

There is no doubt that the Electronic Medical Record (EMR) has changed the practice of medicine and there is much debate about both the positive and negative impacts from the perspective of the provider. I don’t intend to get into that discussion now. What is disturbing however, are the experiences I have has recently that demonstrate the general lack of commitment to changing the operating environment in many medical practices to enhance the experience for patients. I will pick on one instance recently, that demonstrates this clearly.

In advance of a visit to my primary care doctor for an annual physical, I received a text reminding me to go to my patient portal to “check-in.” I was impressed and spent about 20 minutes reviewing and updating my medications, my allergies, my Covid and Flu vaccinations and my general physical and mental health. It was very comprehensive and left no stone unturned. Having used this practice for more than 30 years I was happy to see that technology was finally being used. For several years I had discussions with the founder of the practice about using EMRs and showed him how I used his practice as an example in a negative way, when I made presentations. Now that the multispecialty practice was integrated into a large local health system and had implemented a well-known integrated EMR system, things were looking up.

As I finally sat with the Medical Assistant after a 30-minute delay in the waiting room, she pulled out paper and a pen, sat in front of the computer screen, and began asking me questions. Yup, you guessed it - the exact same questions I answered in the online check-in. As each of her questions were asked, I responded in the exact the same way – “I answered those online and you should have them on your screen.” Her response – “Yes I see that” and proceeded to write the answer on the paper. This went on as she completed the entire online check-in.

Perhaps it was just laziness on the part of the Medical Assistant who should have but didn’t take the time before my visit to compile a summary. Perhaps it was the physician who preferred to have the information in front of him on paper, rather than looking at the screen. In either case, the frustration of the patient was totally ignored, and in a world where medical care is allegedly becoming more “patient-focused” the real world had become very blurry.

A few years ago, I wrote about my experience in a hospital emergency room that was a member of a regional Health Information Exchange. Unfortunately for me, the hospital could not access my records from another member of the exchange because it was not part of their workflow, and they really hadn’t been trained. Hundreds of millions of dollars were spent nationally, and tens of millions locally to do just that. Since I was part of a team that helped build the HIE I was annoyed, frustrated, and embarrassed.

More than $14 Billion was spent on Electronic Medical Records as recently as 2019 and we are clearly never going back to the miles of paper charts lining practice walls. But it is time to step back and truly incorporate these new technologies into the actual workflow of the practice. I am certain that many practices are much more efficient and have designed their operations around technology, but there are too many that have not, and the impact on providers and patients is significant.