Routine Visit to the Family Physician
The electronic medical record or electronic health record (EHR) has been around for several years in healthcare organizations and practices but only until last year has it been allowed to become reimbursable by the federal government. Back in the day, when someone went to the doctor for an appointment, all of their information was stored in a file with pieces of paper along with other file folders in a file cabinet. Then eventually, maybe the office started to electronically convert these pieces of paper into soft copy forms and filed them on their desktop PC while also keeping the hard copy files for back-up. Once the patient left the doctor's office and went to the lab or the pharmacy, they would have to take a piece of paper with necessary instructions from their doctor and then show the lab or the pharmacy their piece of paper to trigger whatever happened next. As one can imagine, being able to store a patient's records electronically and having it accessible to both the patient and their clinicians would be a positive step in the right direction for improved quality of care. Not to mention, the simplicity of reading medical notes in a universal font on the computer rather than the handwriting on a pad of paper could lead to a reduction of errors. In broad terms, EHR makes sense but let's take it to an isolated situation, namely one that I recently experienced.
Just recently, I decided to switch my primary care physician. Her bedside manner was lacking as I consistently felt rushed during my visits. She was fine taking my blood pressure, checking the different bodily systems (heart, lungs, etc.), but your PCP is also supposed to be your connection to other clinicians within the healthcare system and she wasn't good at ensuring that this network was in place for me. Even if a physician has their own private practice, they should have a network built within the medical community. So, I went to someone else.
Now what happened during my visit to the new doctor some people would find irritating, but because I have been in HealthCare IT for several years now, I actually found it comical. My new doc had a third entity in the room, the computer. I'm used to this. I've had other PCP's who routinely used the PC while they were performing my check-up. When I went to get Lasik, my optometrist and surgeon also used the PC while I was in the room and after answering their questions they would type notes in, replacing the old notepad with the click click of the keyboard. But during this last visit, my doc started to have issues with the computer. She thought it might be her lotion on her fingertips and the touchpad mouse on the laptop wasn't registering. She washed her hands and continued filling out the form on the laptop - still wasn't registering. She sat the laptop down on the counter and continued with my check-up and I couldn't help looking at the program she was using. Here I was getting my physical done, but trying to figure out why her computer wasn't working. I then started to troubleshoot, telling her "Well, the cursor is blinking so that doesn't mean it's frozen. But then I don't know this program so I'm not sure..." She said "This is so weird. I've been using this program for a while now and this is the first time that it's done this." I say "Eh, it figures. Since I'm in the industry of course it's not going to work for me!" I started to laugh. She said "Well, don't worry; I'm going to input all your info later in case it didn't save." I also found it interesting that when the computer stopped registering, she went to her clipboard but the original paper form wasn't there anymore because the computer program had worked so well they had stopped making copies. I'm not sure how she would have gotten my information in the computer without having to re-interview me.
Some might say that this type of incident seriously degraded the quality of my doctor's appointment, but I would disagree. I could see how good of a doctor she was as she adapted to the situation and honed in on the most important thing, my physical exam. She continued with the physical instead of lingering with the computer problems. By the end of the appointment, we talked about my health, what I should focus on, if I had any questions, and thoroughly went through what I needed to do next.
Will each physician be savvy enough to balance an exam, diagnoses, bedside manner and technology within your 15-20 minute check-up? What if this weren't a routine check-up, but a more serious type of visit? Does the introduction of a computer into the exam room make patients feel uncomfortable? With time, more health organizations are going to be implementing this type of technology into their practice (if they haven't already). There are organizations that have already invested millions into healthcare technology and now they also have the opportunity to get reimbursed by the government if they can prove that these electronic records have been used meaningfully and provided benefits to patients.
