Everyone who knows me or who has been following this blog knows that I am a strong advocate of electronic medical records (EMR) systems. But, as even those doctors who are currently using one know, EMRs are not a panacea. Even with the balance sheet tilted in their favor compared to paper records, there are still several shortcomings ranging from minor inconveniences to potentially serious issues.
- The structure of the chart. The problems with paper records that EMRs address – lack of an audit trail, lack of security, ambiguous structure – also makes them more inflexible. From a medicolegal perspective, this is a good thing. If you have to make a change, you have to add an addendum; you can’t just add to or alter what was entered previously. This can be especially frustrating if a physician wants to change an impression or plan (or finding) after an employee closes and ‘locks’ the chart. Some doctors also miss the gestalt view of a paper chart with everything visible at once: problem list, medications, previous procedures, dates of testing – although EMR templates are getting better at this.
- Drawing tools. We have an extremely robust EMR system, one that is customizable for each doctor if necessary. And the platform has been stable across multiple office locations with only occasional hiccups. But, as a cornea specialist, the one thing that I sorely miss is a decent drawing tool. Even among other EMR systems out there, the prettier the tool (preconfigured icons, stamps and templates), the less flexible; conversely the more options the tool has, the more of a pain it is to use. There are stand-alone software solutions that professional graphic artists use nowadays instead of pen and paper but alas the drawing tools that most EMRs come with leave a lot to be desired.
- Workflow issues. As I have written previously, generally speaking, the easier an EMR system is to use ‘out-of-the-box’, the more the practice will have to adapt its workflow processes to the software. On the other hand, most larger and well-established practices will usually opt for a more robust and customizable (albeit more expensive) EMR that can be adapted to their tried and true, efficient workflow processes.
- Messaging. Most EMR systems have some sort of internal messaging system and in general these are better than a paper-based messaging system. But because they reside within the EMR, they have to compete for the attention of the user with other features, reports, results and a myriad of other bits of information. Even with the option of ‘tagging’ a message as urgent or critical, there is still the problem of desensitization on the part of the intended reader.
Still, after almost 6 years (in our case), there is no looking back. Increased competition – at least for the time being until the market becomes more consolidated – means more features and improvements. I do miss the drawing, though…