E-day

While walking back from work this evening, something struck me as being remarkable. I spent an entire day seeing patients in my clinic from 9 AM to 5 PM without once needing to use a pen! And I realized that because I forgot to carry a pen with me this morning and didn't miss it once in the day.

Many hospitals and clinics are incorporating electronic medical records including charting and prescribing. Notes are completely electronic, communication between nurses, front-desk staff and physicians is via electronic messaging, referrals and prescriptions are also e-scribed and e-signed. With the security of a provider's password, a lot of important communication and therapy is taking place. It didn't strike me as amazing till I realized that I didn't need to sign a single prescription or hand-write a single instruction note for a patient today. Everything was printed and/or sent electronically.

While it makes health information relatively easier to access and circumvents the need to develop special skills to decode physicians' scribbling, there is almost always an excess of documentation and mandatory tags that follow the note that sometimes buries the real essence of a physician's note. The Center for Medicare and Medicaid (CMS) has announced special incentives for practices and clinicians who demonstrate "meaningful" use of EMR. It is believed that it will make documentation lighter (no paper), cheaper in the long run (perhaps), more transparent, increase sharing among different providers that in turn can decrease medical errors and deaths. For instance, when seeing one of my geriatric patients who has moderate dementia and does not remember his or her allergies, EMR makes it almost impossible for me to prescribe a medication he or she is allergic to. Without EMR, a provider who missed reviewing the allergy list on some specific page of a thick paper chart could easily prescribe a medication that can eventually lead to wasteful emergency room visits and unnecessary admissions. That is one of several ways in which EMR hopes to reduce medical errors and improve health care delivery.

One of the cons of EMR for physicians is the learning of computer skills and smart ways to document efficiently. For some, EMR documentation may need them to stay longer at work in the evening. Also, it may result in lower patient satisfaction if the physician seems too busy with typing on the computer as he or she speaks with the patient, and this may ironically result in lower online 'health-grades'.