Commentary

'It's the End of the World as We Know It'


 

Or so R.E.M. sang, but they added "But I Feel Fine." Is that what we are seeing in our profession? While many might agree with the first sentiment, few would add that they feel fine. Today I’ll focus on one change that has impacted our practice of cardiology: electronic medical records.

The rollout of EMR teaches us once again that what sounds good on paper may not end up being so. Greater efficiency? We have not seen it yet. Better patient care? Perhaps on the margins, but our patients get even less face time with us than ever before. Greater communication? Not when your note runs on for pages. In fact, if I can be allowed to continue with cultural references, I would say that most notes are now, like the show ‘Seinfeld’ – "about nothing."

kokouu/iStockphoto.com

The rollout of the electronic medical record teaches us once again that what sounds good on paper may not end up being so.

We furiously work to document everything because our RVUs depend on it, and our rankings on quality as well. Even if you explain in one note why a patient is not on a particular therapy, who refrains from explaining it in every subsequent note?

And that little man you see on my shoulder as I furiously type is whispering "remember the lawyers!" EMR is a potential gold mine for them. At our last training session, I asked if the lawyers could assess which elements of the medical record we clicked on and reviewed, and which notes were left alone. No one could answer the question.

So, I still prescribe ACE inhibitors, beta-blockers and aldosterone antagonists just as I did before EMR. I still look at neck veins and roll the patient into the left lateral decubitus position to listen for a left-sided third-heart sound. But I find myself obsessing with EMR notes to prove that "I was there." So far, the patients appear to be relatively nonplussed; compassionate, even. "I know you have to do that doctor, don’t worry about it," they say as I apologize and pivot back to the screen.

Dr. Paul Dudley White may have also thought about the end of the world as we know it, when catheterization went mainstream prior to his death in 1973. It wasn’t. But the inefficiencies and chaos associated with EMR adoption, if not the end of the world, certainly haven’t made it any more fun, either.

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