January 30, 2019

Electronic Medical Records – Tips to Create Efficiencies and Reduce Stress

In a recent article from The New Yorker, “Why Doctors Hate Their Computers,” the question is asked, “Digitization promises to make medical care easier and more efficient, but are screens coming between doctors and patients?” While the author of that article, Atul Gawande, addressed several themes in his story, his writing certainly hit home with some of the challenges I face with electronic medical records (EMRs).

On typical days in the Intensive Care Unit (ICU), I arrive at the hospital in the morning with many patients admitted the night before, and the ICU nurses are questioning me for patient orders. So my day begins, I eagerly tend to my patients, and hours later, it is time to document all I have done. This is where the frustrations begin!

I can’t log in to the system peacefully. I have to sign and acknowledge the many telephone orders I had given the day and night before. Then, I try to write a note, and the EMR gives me a “Best Practice Alert,” irrelevant to this particular patient. I haven’t even finished writing the note when a bedside nurse comes to me for another patient’s order, and I have to interrupt my thought process to put in that order. Moreover, I have to recall myriad regulatory acronyms for the system.

Physician burnout is a major problem with more than half of U.S. physicians experiencing symptoms. Adding to the burnout can be the stress associated with non-medical issues like software and systems.

These Practical Tips Can Help

With all this said, documentation is a must and time well spent, though it can be challenging. Here are three EMR tips that can help make documentation more efficient:

  1. ​Develop and use macros! These are long statements/phrases/paragraphs that we use on a regular basis that can be “dropped” by using an acronym or simple set of character strings. Different EMRs have different names for them, but these macros are very helpful, and they can slice precious seconds and minutes off of the time it takes to write an intelligible note. At my program, I have more than 50 macros I use on a regular basis.
  2. Dictating the body of notes has helped me tremendously, as I can dictate one paragraph or multiple paragraphs much more quickly than typing.
  3. Some copying of the previous day’s progress note can be helpful, especially if not much has changed, but we should ALWAYS make updates with the latest developments. Are the problems better, worse, or unchanged?

While the advent of EMRs was inevitable, and they have certainly helped the delivery of healthcare in America, they are not without problems. No EMR is perfect. We as providers have a critical role in making them work better, which will translate into them working better for our patients. However, if and when EMRs don’t work well, we should be proactive in their improvement and in delivering feedback to IT teams. Our patients’ health, as well as our own, is at stake.

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