EMR: Efficiency Mauled Repeatedly

John L. Marshall, MD


February 03, 2012

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This is John Marshall from Medscape. Happy New Year 2012. It is going to be a great year. It is a year of new technologies and moving forward, and I have been thinking about this because I have been spending a lot of time every weekend on the computer with the electronic medical record (EMR). This was going to be a great thing, right? It is a great thing in many ways. We have been using our EMR for about 3 years now, and as such we can always find the chart. That is good. We can get it remotely, wherever we want to. We can e-prescribe and send prescriptions right to the pharmacy without any trouble. But you know what? Our group here has been rumbling a lot about the EMR because it has brought more and more physician responsibility, with less and less administrative support to help us maintain this EMR.

We have basically become highly paid data-entry specialists. We are sitting there typing our progress notes and faxing things ourselves and ordering labs ourselves and ordering CAT scans ourselves -- in some ways, reducing our efficiency. I have been doing some polls of other oncologists, particularly academic oncologists, and they are saying the same thing, that they are spending more and more time interfacing with that computer and having less and less time now for patient care when, in fact, the EMR was supposed to improve efficiency.

I have been thinking about this on multiple levels. One, how do we get the right level of support? Who are the right folks who can come in and help us enter the medicines correctly and do medicine reconciliations appropriately? Is this a nursing role? Is this a nurse practitioner/physician assistant role to help us with that to make us more efficient? Just how much time should we expect to spend outside of clinic on a daily basis to manage and maintain and keep up the EMR? We talk a lot around here about "percent effort in clinic," and some doctors are in clinic 6-8 half-days. How much time outside of clinic? In the old days, it wasn't quite as much as it is now because that "efficiency machine" is making us spend more and more time. I have even heard one estimate that for every hour in clinic, we spend the same amount of time outside of clinic doing documentation and data management.

It is an even bigger issue in clinical research, because we have to document very precisely. Growing up with the EMR, we are seeing its advantages, but we are starting to recognize some of the disadvantages of this system, that all of that responsibility can be put on the physician. We are thinning out the administrative support that we have. Ultimately, we are over the curve of efficiency where our doctors are not as efficient as they need to be. We need to think about this and look at it. I welcome comments on how we can improve our efficiency in the context of an EMR, ensure that we have the right and best data in there, but keep us doctors doing what we are paid to do: interact and think with patients -- not sit and hunt and peck.


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