Electronic Records & the Lost Art of Medicine | |
Electronic Records & the Lost Art of MedicineDr. Paul Farmer, a pioneer in global medicine and champion of those for whom medical care is as remote a possibility as their locations, passed away in Rwanda this week. My children worked alongside his group, Partners in Health, in Haiti during the aftermath of the 2010 earthquake.
Farmer and people like my own children, who founded Floating Doctors (FD), a global medical aid and capacity development organization, have created outstanding community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings. Volunteers from FD are about to launch a new, patient-centered electronic medical records platform.
There is no doubt electronic medical records can play a useful role in patient care, but they can also be a real distraction from good clinical care. According to Medscape.com, “there is a general consensus that clinical skills, history-taking skills, and physical examination skills have progressively deteriorated during the past 15 years.” So, it is important to understand the value and hazards of electronic medical records as you negotiate your own health concerns.
What is an EMR?
EMR stands for electronic medical record. Before EMR’s, patient histories were kept on paper charts in a medical practice or hospital. Peter Garrett and Joshua Sideman, writing for HealthITBuzz, explain that “an EMR contains the medical and treatment history of the patients in one practice. But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out, faxed or emailed to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.
What is an EHR?
Electronic Health Records are a next-generation advance in digital health records. They have all the information of the EMR. They also contain all the information from all the providers for a patient, including office visits, lab results, x-rays, specialists, pharmacies, hospitals, nursing homes—the total picture of the patient’s history. These records travel with the patient beyond the providers that collect the information. All members of a care team have ready access to the latest information allowing for more coordinated, patient-centered care. Dr. Ben LaBrot, founder of Floating Doctors, whose first call was Haiti in the aftermath of the 2010 earthquake. |
 Photos Courtesy of Floating Doctors The late Dr. Paul Farmer, a pioneer in global medicine, first met and worked with La Brot and his team in Haiti. Early Beginnings,
Problems and Stakeholders
An article from PubMed Central of the National Institute of Health’s National Library of Medicine reports that electronic medical records were developed for billing purposes, not for research and quality improvement efforts. Herein lies the problem for providers. The providers are forced to spend inordinate amounts of time as data entry clerks. If they don’t fill in all the boxes presented to them, they don’t get paid for their work. And you wonder why your 15-minute visit includes so little actual communication with your provider!
A doctor’s narrative note, the fluid recording of the patient’s history, the impression or analysis and suggested treatments, is constantly interrupted as the doctor is pulled away from the narrative to check boxes which often have nothing to do with improving the quality of health care delivered to the patient. The patient becomes a checklist, not a person, says Timothy Snyder of Yale University. There are templates for histories and physicals, follow-up visits, procedure notes that have boxes to check that providers document, but have not really done. (If it’s documented, you’ve done it. If it’s not documented, you have not done it, even if you have, and you won’t get paid.) This causes the medical record to be often inaccurate and unreliable.
Robert Wachter, who leads the department of medicine at the University of California, San Francisco says making providers data drones “had become a main contributor to the growing problem of physician burnout...during the day, doctors at UCSF Medical Center spend much more time on their computers than they do with patients, he says, and they still need to spend a further two to three hours in the evening catching up on data entry.” Have you tried to find an internist or pediatrician lately? Geriatric care for the aging is disappearing. The lack of reimbursement and odious administrative and documentation demands mean a lot of folks will be getting primary care in an emergency room. Clearly, improvements are necessary.
It’s the Medical ARTS,
not the Medical Business!
Last November, Dr. Ben LaBrot, founder of Floating Doctors and a home-grown Topangan, was invited to speak at the World Extreme Medicine Conference in Edinburgh. His speech is called “Searching in the Jungle for the Lost Art of Medicine.” Providers so want to be allowed to practice this kind of medicine, the kind they anticipated they would enjoy when they decided to go to medical school, far out of reach of the many masters who, according to Snyder, “seek to pry open every aspect of medical practice for profit.” Ironically, it is in the remote and impoverished areas of the world that a modern doctor may find the opportunity to practice what Paul Farmer refers to as the “privilege” of caring for a patient.
As for the future of electronic records, well, just as there are new platforms springing up to compensate for the monopolies of the social media tech giants, so organizations like Floating Doctors are innovating more patient-centered electronic record platforms for the future.
Hang on!
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