The Tyranny of Electronic Medical Records

Paul Pender, MD, Vxtra Health Director of Digital Health Communications

Recently I heard my primary care physician compare the stress and frustration of her hospital-based electronic medical record (EMR) to that of COVID, and she said that her EMR system was worse! After the shock wore off, I attempted to understand what that meant from her perspective as an internist working in an outpatient setting. One might see the end in sight as more and more people are vaccinated. One might expect that because there is light at the end of the pandemic tunnel, attention might shift to another major challenge.

As my doctor explained, her EMR was designed for hospital in-patient work, not for outpatient encounters. It takes her additional time and energy to have to activate work-arounds for her computer entries. Far too often, she becomes frustrated by how slow her system works because of the bolt-on patches required of the software. She is not alone. Hundreds of doctors in her hospital system face the same challenges as they attempt to document their work. She offered a very memorable image to describe what she experiences: “It feels like I have a kitchen sink full of dirty dishes, and all I have to work with is a dripping faucet.”

What she needs is speed and power to get the documentation job done, but the information management system she is forced to use simply cannot accommodate. Her hospital may eventually merge with an academic medical center with a better IT platform, but from my experience, that system will also likely have major problems, even for experienced users. Users can’t move from one function to another until their “alerts” have been addressed and completed. Yet, the vast, unspecified, generic alert derived from the very popular software used by hospitals has the same effect as junk mail. You want to ignore or delete it—but you can’t.

Despite the surgical mask obscuring her face, I could see the look of resignation in my doctor’s eyes, borne of frustration from the clerical demands imposed on clinicians. I knew and understood that look. Before I retired from medical practice, I had hired a scribe, at my own expense, just so that I could get through the day of seeing patients and completing the required computer entries. That is not what we signed up for when we became medical professionals.

Samuel Shem, the author of House of God and Man’s 4th Best Hospital, describes the electronic medical record computer systems as “cash registers.” These systems have become the masters, and the doctors have become the slaves. This scenario is played out every day in the clinic, and physicians have begun to revolt, albeit quietly. They are tired of doing what they consider busywork for their employers, the healthcare insurance companies, and the federal government. For confirmation, scan the subjects and essays on, the most influential social media platform for physicians.

To escape the tyranny of electronic medical record systems, doctors should make a counterproposal. That proposal should include principles for how data are gathered and what purposes, besides billing, are being served. Doctors who look for guidance for decision-making, from registries or other sources of data that accumulate thousands of encounters for what ultimately constitute best medical practices, will find actionable intelligence for their patients’ best interests and health outcomes. Documenting a history and physical exam is an essential practice, but it should serve a purpose more in line with its ideal: to help doctors and their teams optimally manage the health of their patients.

A better way to collect and use such data would be to create a cloud-based, secure, open-architecture platform that allows multiple views within a single system. This is the principle behind SEYMOUR, the information-sharing system of Vxtra Health. SEYMOUR enables analysis and provision of important data to all members of the health care team—doctors, nurses, pharmacy benefits managers, and employers. Best medical practices are derived from both academic and clinical inputs based on outcomes that can be obtained from the data, with the shared goal of better patient health. The system becomes a reliable partner, rather than a tyrant.

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