By Mary Jane Minkin, MDClinical Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine; and Obstetrics, Gynecology and Menopause Physician, PC, New Haven, CT.
I have never minded spending any amount of time when a patient needed me or to do anything that bettered patient care. I am sure that none of you have ever minded being awakened at night by a patient who was ill and needed attention: hey, we’re ObGyns. I would not object to spending any amount of time on the conversion to an electronic medical records (EMR) system if I thought it would really benefit patient care. But I am convinced that it does not.
To me, the value of an EMR system is to have the baseline EKG of a patient from New Haven accessible to a physician in an ER in San Francisco, for example, if the patient develops chest pain while visiting. This would be of value, and this is what the American public has been sold on as to the value of an EMR system. But this is unlikely to happen because the company who is handling the EMR system in New Haven is unlikely to be using the same system of the company servicing San Francisco, and these two systems are unlikely to be able to “speak” with each other.
The other concern I have is confidentiality. Our system is being touted to us as being the same system from our hospital going into our community. That is lovely. However, I take care of the Significant Others of many hospital physicians. Let’s say the patient is concerned about STDs—she’s been seeing another person, or she is suspicious that her husband has been fooling around. I do the STD panel. Two clicks and this physician can access her partner’s results. Yes, I know that is illegal and that there are supposedly safety checks for privacy, but Julian Assange didn’t have too many problems getting our state department records, and I doubt these EMR companies have installed security checks as “secure” as our state department. At least I don’t allow the Significant Other in my office to look at my patient’s chart.
How am I going to resolve these conflicts? I don’t know. Although there are some advantages to the EMR system with which I have been working, what is tragic is that the companies clearly had zero input from the specialties they are supposedly serving—not bureaucrats but health care providers in the trenches, particularly for many years. EMR administrators need to remember that many of us are partially Luddites: we have gone into medicine because we love to take care of our patients, not computers. Most of us like to talk with our patients, not to sit in a room with a computer, entering their answers into a machine. I have been told that the physician/author/humanist Dr Abraham Verghese has referred to the tragedy of the “iPatient” in this EMR era. I never want to retire; I want to take care of patients till the end of my life. I don’t want to take care of computers.
To read part 1 of this blog, click here.