How We Got Here From There In the Past Ten Years

For all who hate computers in medicine: here’s what we got before.

Acknowledgment to ePatient Dave DeBronkart

The photo below shows what “visit notes” from a doctor's appointment might look like in the era before computers. Just two days before my first speech where I said “Gimme my damn data,” I had an ENT visit, and on the way out I asked for a copy of the doctor’s notes. The clerk snickered out loud and showed it to me, saying, “If you really want it….”

No joke; this is what the doctor had recorded.

Visit notes from my ENT appointment, Sept 15, 2009

The photo above shows what “visit notes” from a doctor's appointment might look like in the era before computers. Just two days before my first speech where I said “Gimme my damn data,” I had an ENT visit, and on the way out I asked for a copy of the doctor’s notes. The clerk snickered out loud and showed it to me, saying, “If you really want it….”

No joke; this is what the doctor had recorded.

The horrible usability of many of today’s EMRs has understandably caused a lot of bitching from their users (clinicians). I totally empathize and I want it fixed. I’m grateful for the dozens of very smart people whose years of study, training, and clinical experience helped save my life in 2007, and I want them to have a good life, not one filled with horrible machines.

But the remedy for usability problems is not to go back to paper, it’s to force vendors to fix it. (I spoke in 2010 and blogged the video in 2011 about a major reason for the usability problems: the EMR executive who was strongly rumored to have said that usability would be a system criterion “over my dead body.”)

Another example: Peter Elias MD (retired), my colleague in the Society for Participatory Medicine, says that when he repeatedly asked his employer (a large medical center in Maine) to grant patients access to all their chart data, every time the management said they couldn’t because the data is such poor quality. (That is now a federal crime as per HIPAAs latest update.

Peter loves wisecracks and perverse aphorisms; his email signature says “The chief cause of problems is solutions.” We cannot assess solutions to system problems without remembering why the systems were needed in the first place: pages of crap like that were of no use in improving healthcare, or even in knowing what was going on nationwide. (Imagine being an E.R. doctor or someone providing coverage for a doc on vacation, and having to practice medicine based on that sheet.)

For healthcare to achieve its potential, the information gathered by smart clinicians must get digitized, the same as all the other information in every other industry in the world. If the systems to do that are bad, we should insist that the vendors fix them – not return to scribbles.

We have come away with meaningless usability metrics from HHS so they can collect data. No change has been forthcoming in the usability of the system for the doctors.  I have been harping on this since 2005.  HHS bribed the whole bunch us by financial incentives. No one in their right mind would buy one of these EHRs (unless someone else paid for it.  We got what we deserved and for which we did not pay.

 For healthcare to achieve its potential, the information gathered by smart clinicians must get digitized, the same as all the other information in every other industry in the world. If the systems to do that are bad, we should insist that the vendors fix them – not return to scribbles.















https://www.epatientdave.com/2020/01/07/for-all-who-hate-computers-in-medicine-heres-what-we-got-before/


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