EMR's Paper and Healthcare Innovation

EMR's are essential. They are going to bring healthcare into the digital age -- finally! Healthcare organizations are spending billions of dollars to implement EMR's, and the government is doing the same.They're preparing the ground for the incredible benefits of Big Data and Cognitive Computing!

There is no doubt that the money is being spent. EMR's are certainly being implemented. Are they working? Eliminating paper? Not so much. One thing they are certainly doing is making doctors spend less time with patients and more time with computer screens.

I could go wild with statistics, but all this got tangible for me when I accompanied a family member to a surgical procedure with a top-flight provider at a first class facility in Manhattan recently.

Here is the notebook of papers that accompanied the patient everywhere:

Some of the papers were computer-generated, but most were not. We spend loads of time fielding questions whose answers had already been entered into various systems -- including the provider's! Various papers whose text had nothing to do with medicine had to be signed -- papers concerning regulators, administrators and lawyers.

I heard the dialog in other booths, with huge amounts of time trying to get information out of the memory of patients and onto paper. Here is a nurse doing her job:

I could see that there were also lots of computers all over the place. Not that it mattered.

It turns out that the medical care was excellent, and the procedure successful. Good news! Would eliminating the paper have made it better? Hard to see. If the medical history had already been available, would it have saved some time? Well, the medical history was all available -- the provider had already gotten everything required and entered it into his own system before agreeing to conduct the procedure! So everything done at the hospital was just a bunch of wasted effort anyway, whether it was on paper or on computer! Could the provider's EMR have transferred the information about the patient to the hospital's EMR for this scheduled procedure? Maybe. But it didn't happen, and we know from government statistics that it rarely does.

Tens of billions of dollars are being spent implementing EMR's so we can experience the wonderful benefits of getting rid of paper. Sounds good, but I suspect that no true science or even engineering has been done here. How do we know things will be better in the gold-plated EMR future? Has anyone done patient outcome studies? How about time utilization studies? Has anyone tried alternatives? After all, EMR's can't possibly be a goal -- who cares about EMR's except EMR vendors? EMR's can only be a means to an end; and the only end worth anything is better patient care at lower cost.

What we know for sure is that we're achieving higher costs by implementing EMR's. We're not eliminating the paper. Too much of the data that ends up in the EMR is crap, and too much is missing or wrong. We're not getting accurate data into a single place. We don't have a clue whether we're making patients healthier as a result; we don't know whether we could make patients healthier by spending the money in a different way. Maybe it's time to apply some fresh thinking here.

I'm computer guy. And a facts kind of person. I know that computers and software can make things better for everyone in medicine. I'm NOT saying we should forget this new-fangled computer thing. I'm saying we could get dramatically better results for a fraction of the money we're spending.