Electronic medical records stifle American medicine


Last month , 15,000 nurses Strike in Minnesota in the largest private nursing strike in US history. They were protesting against staff shortages and burnout at a time when service provider fatigue reached epidemic levels — almost 63% of doctors And the 80% of nurses Now report symptoms of fatigue. Meanwhile, health care continues to suffer from enormous cost pressures. We are still spending More money for worse results than any other developed country. As a resident, I’ve heard plenty of structural explanations for cost and burnout issues that ignore a definitive, fixable cause: Our electronic medical records (EMR) are still hopelessly broken.

In 2022, the program is stifling American medicine.

The 2009 HITECH Act launched the modern era of EMR with federal incentives for the use of EMR. Unfortunately, the legislation too Existing companies are preferred over smaller competitors with its multiple requirements and short time frame. Today, many high-profile hospitals use electronic medical record records from a vendor, Epic systems or Cerner Corporation (Now part of Oracle). Epic alone has medical records on 250 million peopleCerner won a medal A contract worth $16 billion To submit EMR to the Veterans Health Administration. These companies have sum he won Nearly $10 billion in 2021, with double-digit growth year-over-year.

Despite the swell in funding, I haven’t experienced any significant upgrades to Epic or Cerner EMR systems in the past eight years. I find the interfaces comically untidy. I often stare at screens with 30+ tabs and when I click on one the system stutters and lags before displaying the result. This flawed user experience slows service providers down significantly. in one study From an orthopedic clinic in North Carolina, Epic’s EMR certification increased physician documentation time by 230% and increased labor costs per visit by 25%. Family Medicine Doctors you have worse: Many spend a whopping 6 hours a day on EMR. Nurses often spend more time Chart in EMR more than any other task. Multiply that by the entire healthcare system and the idea that Additional MRI here and there Driving our cost crisis looks funny. Every day, expensive doctor and nurse labor is wasted through unnecessary clicking and scrolling.

The exacerbation of daily idleness, time spent away from patients and increased clerical burden combine Fatigue, sarcasm, and reduced effectiveness Known as burnout. More than 8000 nurses survey last year Their EMR gave an average score of “F” in ease of use, and usability directly correlated with fatigue symptoms. Among the physicians who reported the use of EMR, reported 70% EMR-related stress, with “high” usage doubles the potential for fatigue. Why is fatigue important? Because burnout leads to more burnout, as well as higher costs and worsening care. under conservative estimatesReduced clinical hours and physician turnover due to burnout costs us $4.6 billion annually. quality care It gets worse when nurses report symptoms of burnout, regardless of the practice environment. Exhausted providers sometimes leave the workforce altogether, exacerbating staff-to-patient ratios and leading to more burnout in the workplace. vicious circle. In large part because some high-quality, mind-numbingly slow software takes up so much of our time.

Inefficiency with current medical record records is sometimes attributed to poor training. Veterans Health Administration delay Its implementation of the Cerner EMR system because providers have proven difficult to train. This is fake. Well-designed programs for data entry and retrieval should be intuitive enough that they do not require dedicated training. Nobody needs training to learn how to filter out millions of listings for Airbnb listings, flights on Kayak, or local businesses on Yelp. You can find what you want, check availability, and even submit a review, all within seconds. The information I need as a doctor is no more complicated. I need to see a concentrated list of patients, and then an ordered grid of their digital information. I need to go through text entries and scroll through images, then start typing with a blinking cursor. This is it. It should happen right away, without you having to think about it.

Instead, it takes 3 minutes to request an X-ray, 60 seconds to pull the image, 5 minutes to find background facts, and 90 seconds to upload an MRI. Then there are two minutes left to see the patient. What we need is not ‘training’ but design thinking and problem solving first principles. What do doctors need? What do nurses need? How might they want to see the information provided? How do they want to enter the information?

Take for example another well-known software company, Google. Google tested what users wanted, coming back over and over to a one-word answer: speed. A small 400 millisecond delay in search speed results in lower search volume, and four out of five users click away when the video pauses while loading. For Google, “Speed ​​is not only a advantage, is The Property.Google engineers work with a fixed ‘budget’ for the total amount of time (say one second) that users can require to complete a single step. EMR creators should take the same approach: measure and speed up how long each action takes. Simplify the interface. Store data more More efficient.Whatever it takes.

To repair EMRs, one suggestion Money has been put on the line by fining hospitals for the burden of EMR the way fines are imposed for infections or bedsores. This would be a welcome change, but passing a healthcare policy that undermines vested interests is a huge challenge, and it can’t be the only strategy. While advocating for legislation, we also need to build EMR for the future. We need an explosion of the kinds of quick, simple tools that technology innovators are now adept at creating. To achieve this, professional associations and hospital groups must fund an EMR X award of some kind for supercharged innovation. Projects should be ranked according to speed, ease of use, and interoperability – everything that current EMR companies have failed at over the past decade. Just focusing on politics will keep the actual solution, a better product, in the realm of abstraction. Instead, build it first, and show doctors, nurses, and patients what’s possible.

Dane Brodke, MD, MPH, He is the chief medical resident in orthopedic surgery at the University of California, Los Angeles.


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