Learning to Love Electronic Medical Records

Christina M. Sorenson, OD


May 09, 2016

True or false: I enjoy trying out a new electronic medical record (EMR). The answer may surprise you, but it's true. It is always interesting to try out a new EMR.

To see what has been hard-coded into a program or what "cheats" can be found within it is akin to solving a puzzle, but this can also really frustrate the user. Having to repeatedly find a descriptor or a diagnosis one too many times can cause a user to utter an expletive and walk away from the computer.

We all know how to document, where to document, and how to code, because these tasks are extremely important to good charting and patient care. Learning how to accomplish them in a reasonable time frame and with accuracy can be challenging, even in a familiar EMR.

It is informative to see where certain tests have been placed within the program. This almost certainly belies the point of view of the physician consultant, right? It could not be the programmer deciding that this test fits here, or cosmetically it looks best there—nope, never. For example, you may find topography as part of the corneal evaluation or refractive analysis, or isolated in specialty testing.

Another unique difference is how testing is viewed. Certain tests require separate interpretation, whereas others are able to stand alone without a dedicated interpretation field. Rarely do you find intraocular pressure interpreted separately. Yet, in a glaucoma-devoted EMR, you may find pachymetry and several types of tonometry in a data field with an additional requested interpretation. I believe this type of customization ultimately enhances patient care.

To date, I have used over a dozen different EMRs. Each time, I am excited to investigate the innovations of the program. Yet, the mixture of radio buttons, drop-down menus, and click-and-drag options can be irritating, because they seem to change the rules of the game just when you think you have the program figured out. Could they be placed by the programmer because of boredom, or with wicked delight to vex the end user?

My least favorite feature is autofill. I am always piqued by it; everything defaults to normal. This could be a time-saver if you actually encountered such a patient. Maybe one day, if I am in practice long enough, I will find an "autofillable" patient. In my opinion, autofills always run amok. Do you really perform the full battery of testing recommended by the autofill? Is everything really normal?

Ideally, we need more smart-programming. As EMRs evolve, we will see complaints tied to testing, medications tied to diagnosis, review of systems associated with medications, all phoropter testing downloaded, and voiceover video of anterior and posterior segment examinations—and all of these populating diagnosis and coding accurately! When this happens, then the autofill feature will really enhance your charting. However, until then, I will continue going back and forth between what the program has filled in and what applies to my patient.

So it is true that I enjoy evaluating new EMRs, knowing there are limitations and that I must continue to chart mindfully.

This technology is changing fast, and many of these ideal outcomes are available in rudimentary forms now. And the truth is, I can't wait!


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