With EHRs, Sometimes Less is More

The clinic where I practice hasn't got what you would call an electronic health record. It has something akin to the rag-tag fugitive fleet of ships from "Battlestar Galactica," on a lonely quest … a core system that is used to register and schedule patients, a lab system, a radiology system, and a document imaging system. The nurses transcribe physician's orders into an order-entry module and lab results are reported back and can be viewed on a screen that looks a bit like a spreadsheet.

When it's time for me to write a note, I use a word processor on my laptop. I have a template that sets the page margins to match our progress note forms. I then take the patient's form, on which the nurse has recorded the vital signs, and run it through the printer. I sign it and it goes to Medical Records where it is scanned. If the patient needs a prescription, I just handwrite it. There is an "e-prescribing" application but it proved to be so cryptic, annoying, and generally ghastly that I have avoided it.

To read a patient's chart, I use the document imaging system. I can read the notes, and since mine are all typed, I can actually read them. The ophthalmologist's notes are also typed but they are so laden with proprietary abbreviations that they are effectively illegible. When I order a chest X-ray, I am able to view the image within a few minutes after it has been taken, often before the patient returns to the clinic to complete the visit. There are a few things I can't do. I can't look at the patient's problem list or a growth chart because the system does not provide them. It can't even show me a historical summary of heights and weights.

Although at first the situation sounds bleak, it's pretty functional. It only takes me two minutes to three minutes to do the paperwork for each case and I never go on to the next patient until I have finished with the current one. I have no backlog of incomplete charts.

In summary, my "electronic health record" is almost exactly like the paper one. I have to look at the same three sources and each display is optimized for the information source - progress notes as pages of text, lab results as spreadsheets, and X-rays as images. I am never forced to enter something incorrectly into the computer just so that it will accept my work. I am never distracted by nagging warnings that are not relevant to my practice.

A friend of mine works at a facility where they have installed one of those high-priced EHR products. It has a few functions that, I have to admit, I would find useful - but on Friday's, when I see him, he is still working on Tuesday's charts. On those rare occasions when I might use one of those missing functions, I realize that I have saved so much time by using my simple approach that I can afford to occasionally spend a bit of time doing something the hard way.

What I'm doing is nothing like what people expect or imagine an EHR to be - but then, I always get home in time for dinner and, since I have no cases waiting to be charted, the quality of my work never falls victim to the vagaries of my memory. When I stop to think about it, the current arrangement is not so bad. I know what the organization has decided to do next in the way of EHR and I'm not looking forward to it.

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