Leonard Zwelling

         A close friend recently forwarded me an article and editorial from the Annals of Internal Medicine (165:753 and 818, 2016). The article describes the results of a series of time-motion studies examining the actual time doctors spend with patients vs. the time they spend with the electronic medical record (EMR) and other administrative tasks.

         Not surprisingly the study demonstrated that physicians are spending 27% of their time on direct patient care while spending 49.2% on the EMR and other administrative tasks. I know, I know, you could have saved them the time and told them that if they had just asked. At least in the examining room, the docs spend more time with the patient than with the chart,  but that time in the room is limited by the EMR and its demands. The caregivers also reported at least 1 or 2 hours of additional after hours work each night to keep up with the paper chores.

         None of this will be a surprise to the physicians with whom I have worked at MD Anderson or at Legacy. Most of the pediatricians who were seeing a patient every 15 minutes at Legacy had 2 to 3 hours of chart work to do at night after a busy clinic. And most clinic days were busy as the operations people were packing the templates with patients even putting in walk-ins as the scheduled patients failed to show up.

         Alas, this is the state of health care delivery in 2016 and as Drs. Kantarjian and Ho opine in the Chronicle, this is not even accompanied by superior outcomes (http://www.houstonchronicle.com/news/houston-texas/houston/article/Kantarjian-and-Ho-Health-care-access-in-U-S-10794360.php).

         The question is no longer whether or not the EMR in its current iteration was a good idea. It was not. The question is, as the Republicans like to say about the ACA, how do we repeal and replace the EMR? Can that even be done?

         Of course it can, and believe it or not, the government could help get it done. Here’s how.

         First, if EMRs and their meaningful use are going to be mandated so that healthcare providers get reimbursed the maximum allowed by law, then these systems simply must be interactive. Any one will do but the one chosen by any provider must be able to talk to all others. There must be a common language for these data repositories.

         Second, realize that if we had a single-payer system and all forms of discrimination for health concerns were outlawed, the value of the information in the EMRs would only be to the patients and the doctors not to insurers who really ought to be eliminated anyway. Then the restrictions on the use of the data in the EMRs for research purposes could be done away with and the EMRs would be bifunctional—patient care and research.

         Third, when we design the new EMR that can be used by all for free (taxpayers support it), let’s make sure that actual caregivers are involved with its development so that we can keep the clicks per patient to under 100 per visit.

         These are simple fixes, but they really entail a scrapping of the current EMRs and the design of a new one to serve all—except the billers, coders, and insurers who are currently feeding at the trough of the EMR.

         EMRs have not cut costs nor enhanced quality. They have lengthened patient care and complicated the lives of caregivers. They should be declared a failure and the US should start again with the development of an electronic system built around the patient, not one based around the payer and biller. What a concept!



Leonard Zwelling