Letting Go of The Screen (My 15-Year Journey With an EMR)

Letting Go of The Screen (My 15-Year Journey With an EMR) 1024 683 William Long, MD

Has the electronic medical record ruined medicine?  For those of us who trained pre-EMR, this conversion was a difficult change.  For ALL of us, regardless of age, the burden of charting and data entry is a significant reason for the alarming numbers of burned out and unhappy physicians.  There are many written opinions on this subject, so I would like to just focus on my continuing story of how this electronic partner has affected my interaction with patients.

Our practice first “went live” with electronic medical records in 2003.  It was a long and painful transition for a group that had many cumulative years of paper charting.

However, after the initial transition from paper was over, and the electronic chart was populated with all of this excellent data, I relished in having the information at my fingertips.  A slight touch of the screen or a click of the mouse, and I was omniscient—yes ma’am the head circumference percentile was 57% and yes that prescription was refilled last week, and no you did not have strep throat at that visit three years ago.  I was a wizard.

But, my “superpower” came with a price.  The computer competed for my attention.  I could not resist the urge to multi-task, and I would handle staff messages, or refills for other patients, while a parent was talking to me about some minor detail.  This multi-tasking caused mental fatigue and distraction.  Instead of the Wizard of Oz, I felt more like “that man behind the curtain,” furiously pushing levers, clicking left and right, with my eyes darting in many places—only some of which were the faces of my patients.

With much self-discipline work (and a few patient complaints), I gradually got better, but not entirely.  We changed EMR products.  We changed offices.  I had other responsibilities in the practice that caused me to continue to be distracted when the screen was in front of me.  On my first attempt at not documenting in the room, the screen then became a barrier at my desk, and at home, when I would finish my charting.  Sleep hygiene suffered as well.

Then, I decided that I needed to be like the two-year-old who had to be removed from his pacifier.  I left the patient’s chart outside at my workstation.  I gradually worked out a new rhythm.  I changed my workflow.  Now, I do a chart review of key items before I walk in the room.  I discuss those key items first (so I don’t forget them later).  Yes, I make sticky notes sometimes—just in case.  And yes, I occasionally do have to excuse myself to go recheck something.  It gets harder if I’m running behind.

I now use my computer “boot up” time to practice mindfulness.  I enter the exam room with a free hand to greet the parent, or the patient.  I feel happier.  I sense my patients do too.  At least (so far) I’ve not received a complaint from a family because I didn’t have the computer in the room.  A few enhancements also are helpful.  Parents now have the ability to update histories, and do developmental screenings online, which I can also review and document before seeing the patient.

I’m not completely screen-free in the exam room.  I take it with me for patients with complex health care needs, siblings who have multiple and varied problems, and when I need to review histories in greater detail.  When I do bring the computer in a room with me, I try to apologize in advance.  And I still fight the urge to multi-task.

Being the best medical home provider for a patient involves two basic tenets.  The first is your relationship with your patient and family.  The EMR and the devices could jeopardize that relationship.  The second tenet is being able to KNOW your patient—her/his past history and everything that has happened to him/her.  The EMR can enhance that relationship.

It is a balance that we all have to work out.  And each of us may have different solutions.

Thankfully, I am still learning new lessons.  And my colleagues and patients continue to teach me.  I hope someday my EMR is a flexible screen, strapped on my wrist like an NFL quarterback, and it turns on/off with a flick of the wrist.  Until then, I guess I’ll keep learning as I go through the process of relating to patients, and knowing them better, with my permanent (but now more “silent”) partner—the electronic screen.

About the author

Dr. Long has been a primary care pediatrician for more than 26 years. He is the president of Children's Practicing Pediatricians (CPP) in Columbus, Ohio. He serves as clinical faculty at The Ohio State University College of Medicine and as chief medical informatics officer at Pediatrics Associates, Inc.