Dr. Richard Just clearly lays out a few of the problems that physicians are having with EMRs, but his apparent conclusion and the conclusion of the headline of the article are wrong.

He appears to think that while the current offering of EMRs are poor, we need to “suffer” through them.

Quite the opposite is true in fact. We should not support companies that make harmful products because of the promise that one day they will be beneficial any more than we would give a patient an experimental drug on the promise that one day the company will figure out a different drug that works.

False dichotomies are frequently raised in the discussion of EMRs. For example, unreadable handwritten progress notes are compared to legible electronic notes as an example of how EMR notes are better. However, we are all fully aware of the uselessness of many of the legible but copy-and-pasted notes1 in our medical era or the problems with notes “disappearing” as in Dr. Just’s example. The fallacy is that notes have to be either in a certified EMR or handwritten.

In my hospital, hand-written progress notes are still the norm, but when I round, I type my notes into my laptop, using lots of custom macros and scripts to aide in the process, and put the printed note into the chart. It’s certainly no Hitech, Cchit, MU EMR, but it is fast, reliable, secure, and legible. Even better, no note has ever magically disappeared because the vitals were not already entered.

As a nerd, programmer, and the one ultimately responsible for the safety of my patients, I declare that the EMRs I have been exposed to are unacceptable and at the same time that there are many electronic, technophilic ways to improve patient care.

I relish the day that I can purchase a quality EMR that makes my work better and my patient’s healthier. Until that time, I will not waste money supporting shit but will continue to make my own tools.

Supporting bad products, bad technology companies, and bad med-tech policies, regulations, and laws only delay, and hopefully not destroy, the time when we will one day have something worthy of our profession. Your patients deserve better.

  1. Just yesterday, I saw a patient in consult in which every single physical exam for the last year documented “stippling in the back of the throat, with erythema and purulent exudate”.