I said I wanted to give Amy, my coach from my one on one training session at the PS Suite EMR User Conference May 29-31 in Markham, Ontario, flowers, and I’ve found a way.
I told her that I was well versed in hyperbole, and I may have gushed that she saved me from retirement…I suppose that was over the top…
But that would suggest I was completely happy. Effusive, bubbling in my unbridled enthusiasm for this product. We’ve had EMR for over 7 years now. We reviewed all the major players before our decision, and picked PS Suite. We liked that it was Mac based. Most of us weren’t that comfortable with computers…Macs were simply easier. More stable. Less bugs.
Was that the major reason? Thinking back, it was a major factor. Yes, PS Suite was also hitting all the buttons. We were afraid of internet based systems, looking at security and privacy issues. This one was fully searchable, and familiar enough looking to not scare us off. With a small leap of faith we could almost pretend it was paper.
I have a deep ingrained loathing of the EMR.
Oh yes, I know it’s all for the best. I wouldn’t go back. You know the advantages and so do I. But I hate it, let me be plainly clear. And here we had a company that was going to de-emphasize the Mac angle. Or such was the scuttlebutt.
I had it all planned out. I was going to just sit down and ask my trainer to teach me how to do searches of my patient base. I wanted to know how to use the computer better, to get lists of smokers, for example. You already knew? I had just asked others to do it…
You see, when I started out in university, in 1979, my classmates that were stupid enough to be going into computer science were queueing up at 0200h to punch holes in cards. How many of you have seen vacuum tubes?
But I just let it spill out. I still don’t know why. I sat down and said, “You know, when I started, I had a stack of labs, in paper on my desk.” I just went through them, fast. I needed charts for probably 10% or less of them. I gave those to my secretary, while I did something else. The labs came back, appended to the needed charts. The whole thing was done in scant minutes. Now, every lab result is appended to a computer file. Sounds great, but each computer chart download took 10-20 seconds or so. Every one.
Doesn’t sound like much, does it. But now, unlike the old days, we get partial results, you see. Really fast, right on your EMR. The CBC is done first, the lytes, but then you see it all again with the TSH, and again when the folate comes back. You see it again, and again, and again. And have to acknowledge that you’ve seen it, and archive it. 10-20 seconds, 20 seconds, 20 seconds. As a family MD, you get your labs, and all your consultant labs. All their consults, their follow up notes, and all the notes of the consultants they send your patient to. The family MD, the backbone of the Telus PS Suite client list, is at the bottom of the funnel, collecting the absolute maelstrom of data. We have to see every little morsel of it, and do something with it. A family doctor’s interaction with health care is like a pebble dropped in water, with never ending ripples. More patients are seen per day, on average, compared with most consultants. And each one of those interactions has great potential for ripples. Labs, that generate rechecks. Referrals, and re-referrals. Ripples are made that create ripples. And we get it all back to us. 20 seconds, 20 seconds, 20 seconds. Well, often 10. Anyway, an eternity.
It’s been well shown that the use of EMR adds 1-2 hours of work to the typical work day of a physician (Howard et al, 2013). It’s a time saver, yes. Administratively. Not for a health care provider. Quality is higher. Yes. This is not about the achievements or wonderful aspects of the EMR. We stroke each other constantly about these aspects.
Let’s be blunt. EMR takes away coffee breaks, lunch hours, and time from our families. Less time with our kids, less time walking the dog, time away from your spouse. And gardening. And just being a human. Goofing off. The family doctor, struggling in the front line of health care, attempting to differentiate the self resolving from the serious, supporting people with their lives and how to live them better, has become a stressed librarian. Progress notes that we used to scribble are now actually legible. GULP. We have had to pull up our socks. Use templates with which we are unfamiliar. Create and deal with computerized reminders. Time has been taken away from us. We don’t want to short our patients. So we short ourselves, and our families.
So Amy helped. A lot, in just a few minutes. Not everything was fixed, by a long shot. Future aspirations of software developers aside, we still have a grievously slow, plodding instrument that is a long, long shot away from anything close to ideal. Yes, I know it’s helping my patients. NO, I would never go back.
And not a day goes back that I don’t have visions of punting a beloved iMac out my back door. And around the block. Maybe I will some day, just to to make my wee self feel better.
We need to make the whole thing run faster. We need it intuitive. We need the machine to work like our brains and stop trying to make ourselves run like computers. And I don’t kid myself. Things are a lot better. It’s actually being done. Medical records are going on computer. Things are being measured, followed up like never before. One iPhone could have managed the first few space shuttles, yes. Yes, yes.
And I still am missing my coffee breaks. Coffee, I drink. To keep myself sitting at the damned computer.
But this isn’t all sour grapes.
I’ll tell you what Amy taught me in another post, as I am waxing on and on here. The PS Suite EMR User Conference was actually a good experience, with decent food, and enthused presenters. People, even MDs, looked pretty happy… But I suppose they were mostly younger than me. Maybe they never had it easy. Bad, poor quality, unsearchable, things and issues just plain lost, poor followup, but easy. Hate to say it, but the bad old days were kinda good.
Coffee breaks. Imagine.
Like many MDs, I was concerned that PS Suite getting gobbled up by Telus, a faceless stone monolith, would lead to less personal care, and less evolution in product. Basically, what I saw was a human face to a company, a company investing a great deal into development and stability, achieving OntarioMD’s requirements for downloads and use of product after new version development. Multiple bugs have been zapped, work flows for admin staff have been eased (again), no “Anti-Mac” stance was perceived, and a portable version is close to release. Finally an EMR for my iPhone! (Yes, they used the iPhone as their example.)
My new buddy Doug Kavanagh was out in the waiting room peddling his technology that facilitates direct patient involvement with the EMR (see Ocean, blog date 14/ May 6) to woefully few interested physicians. He even had a free pen! And candies! Great idea, but probably not there yet for most of us… We’re still struggling with archiving the stupid lab results, consult notes, images, trying to suck air into our lungs before we go down again…
But great cookies! And some macaroons to take home for the girls.
All in all, a good use of a clinic day, I suppose. PS Suite EMR User Conference 2013. Probably I’ll do it again next year. I think I understand the system better. I can make reminders, and stamps. This should help patients. And, if Amy’s idea gives me 20 minutes a day, just 20 minutes, that’s a home run.
Or maybe at least a thrown ball in the back yard.
Howard, J., Clark, E.C., Friedman, A., Crosson, J.C., Pellerano, M., Crabtree, B.F.,
Karsh, B.T., Jaen, C.R., Bell, D.S., & Cohen, D.J. (2013). Electronic health
record impact on work burden in small, unaffiliated, community-based primary
care practices. J Gen Intern Med. 28(1), 107-13. doi: 10.1007/s11606-012-2192-