Improving the Cardiovascular Patient Experience with Electronic Medical Records

The mandate to transition hospital and clinic records to a digital format by 2015 could dramatically impact the patient experience.

Much to my chagrin, I had to visit my doctor’s office yesterday.  Fortunately, I do not get sick very often, and when I do, I am not a very “patient” patient.

However, I was kind of excited about one part of yesterday’s experience.  I was offered a chance to sign up for a new program called MyChart, “ a free, easy and secure way to view my health information and communicate with my healthcare team.”   Providers around the country are using this and similar products.

When I got home, I promptly logged in and spent a few minutes reviewing past test results and looking at other features like prescription renewals and appointment setting.  I realize I’m probably more of a geek than most people, but I love the fact that I can now quickly view historical cholesterol readings, etc. any time I please.

Apparently, some providers are dragging their feet a little bit when it comes to embracing electronic medical record (EMR) technology.  However, I found a great blog post from Dr. Eric Van De Graaf, a cardiologist at Alegent Health.

He says he is now “favorably inclined” toward EMR after using it for about seven months.

He also gives a great list of pros and cons.

Advantages of EMR:

  • Ability to access it from virtually anywhere  – from an emergency room, a home computer and potentially a portable device. No more waiting until the office opens on Monday to get a hold of a chart.
  • Legibility – Dr. Van De Graaf says, “doctors’ handwriting is the stuff of legend.”
  • More thorough notes – the system addresses issues that could be skipped, e.g., family history, previous procedures and drug intolerances.
  • More streamlined billing – better documentation means better reimbursement
  • Fast and accurate prescription refills – most EMR systems send orders directly to pharmacies, saving time for both patients and providers
  • Better communication between primary care doctors and specialists – notes can be electronically transmitted within minutes after a patient visit

While all of these features seem to potentially enhance the patient experience, Dr. Van De Graaf offers a few words of warning about EMRs that could potentially detract from the experience.

Disadvantages of EMR:

  • Temptation to focus on the computer instead of the patient “This is the complaint I hear more than any other when it comes to patients’ experiences with our new system: My doctor spent the whole visit staring at the computer screen. The method that works best for me is to build my note before and after I see the patient and to never access the computer in the exam room, an approach that allows me to devote my entire attention to the patient during their visit,” says Dr. Van De Graaf.
  • Stilted, mechanical language that is sometimes difficult to interpret – nuances of patient documentation could get lost in a chart where most of the information comes from pick-lists and check-boxes.
  • Takes too much time – voice recognition systems can be fraught with errors, and Dr. Van De Graaf says the current generation of EMR software is nowhere as quick as a Dictaphone.
  • Information overload – when all medical information is distilled to a database it can be difficult to discern what is truly important from what is trivial. In order to bill for the visit the doctor has to select a diagnosis from a list of approved terms, rather than simply describing a symptom. Thus, simple aches and pains mentioned in passing become diagnoses that stick with the patient (a stiff knee becomes degenerative joint disease, a cough becomes bronchitis, constipation becomes irritable bowel syndrome).
  • A great deal of emphasis on using the computer as the intermediary in the course of clinical communication – Before EMR, if a patient called with a question, a nurse would take down the details and call the doctor for a response.  Now, the patient’s question gets sent to a “tasking in-box” where it will languish along with dozens of lab and x-ray results until the doctor logs on to a computer to address them, which can be tough in the course of a busy day.

Dr. Van De Graaf also refutes early government claims that global adoption of EMR would decrease errors and thereby save the US healthcare system $80 billion. “My personal opinion is that this is nothing more than wishful thinking as I have yet to come across a situation where my computer has saved me from committing an error in the course of patient care.”

Despite its pitfalls, in the end, Dr. Van De Graaf’s overall opinion of EMR is positive.  “I like being able to provide my patient a note as they walk out the door; I appreciate having full access to their history when I see them in the ER in the middle of the night; I love having a list of all their prior procedures and surgeries at my fingertips; and, most of all, I value the legibility of Times New Roman over Doctor Scrawl Italic.”

As a patient, the move to EMR seems great.  I appreciate Dr. Van De Graaf’s inside look and balanced opinion as a physician who has been using the system. How is EMR working in your organization?

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