I have a love-hate relationship with the Electronic Health Record (EHR).

To be precise, it’s 90% hate, 6% love. The missing 4%? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.

I’ve been in practice long enough to straddle the transition from paper…to even more paper (thanks EHR, you’re the logging industry’s BFF). In fact, I was on call as a hospitalist the day our facility’s EHR first went live. (I can’t tell you the name of the software vendor, but I’ll say this: despite its name, IT WASN’T).

Given the chaos that ensued that night, I half expected a Terminator to materialize from the future, snuff out my intern, and relay in gruesome detail how this horrendously complex and clunky software would soon become sentient and attempt to destroy mankind—all while billing Medicare an insanely over-documented 99239 “d/c human race” code. You can’t blame it for obeying it’s programming—the software’s prime directive is to maximize the documentation of billable episodic transactional care widgets, right? Hence my “1000 point review of systems negative except as noted nowhere” template.

If it hadn’t wrecked the beautiful narrative of our notes, added hours and hundreds of click boxes to our already overflowing workload, and further isolated every island of fragmented care from every other, one of those little Workstations on Wheels (WOWs…don’t you dare call them COWs!) could make an adorable computer-animated character in a Pixar film. Call him Wall-EHR. A baby with an interface only a coder could love.

Those who’ve worked with EHRs from the beginning, and those who’ve known no other reality (sorry, Millennials) sometimes claim they’ve grown to like, even love(!!) their EHR. I consider this a particularly worrisome form of Stockholm Syndrome, wherein these docs and nurses begin to identify with their tormentor. Can one guy’s waterboarding be another guy’s brisk shower? Here’s why this isn’t acceptable:

Simply put, the Tower of Babel of existing EHRs may not ever talk to one another, but they do share one thing: they come between us and our patients. Staring at a screen to click boxes and satisfy quality measures while figuring out the seventeenth digit for an ICD-10 code—this nonsense robs us of precious time and attention that should be spent on and with patients. I would never advocate going back to paper. Ever. But we need to demand technology that binds us closer to those we care for, technology that lets doctors be doctors. And nurses, and RTs, and case managers, and dietitians, and scrub techs—[insert crucial care team member here].

We on the front lines of healthcare need to stand up and demand that our organizations, government, and tech vendors stop letting the unintended consequences of legislation and technology wreck our sacred relationship with patients while destroying our ability to do what we do without having to tell our kids to stay as far away from medicine as they can. Great technology [insert Steve Jobs fanboy comments here] can be the glue that connects us, so let’s make our voices heard and tell ’em what we want—and need. Health IT policy and technology are constantly evolving, so why should the care team’s voice stay silent? It’s OUR frickin’ workflow, let’s take it back! Leave your gripes—and more importantly your constructive feedback—for the powers-that-be at #LetDoctorsBeDoctors. Your feedback will be brought to policymakers in Washington, DC who are interested in producing legislation to improve the EHR experience. They’ll have to listen if enough of us stand up together and shout. Or rap. Or whatever, just go do it!



The legendary Devin Moore produced and engineered the track from scratch, AND sang the most amazing Alicia KeysBoard rendition that was still street legal in the state of Nevada. If you love him, hit him up on his band Rabbit!’s Facebook page!

Tom Hinueber and Logan Stewart of Variables of Light absolutely KILLED it on the video production, as per routine (see also Bad Skin and Readmission).

Lyrics and rap by Jay-ZDogg, with an assist from Facebook fans Sarah Ann HendersonElizabeth Murray, and Cristy Miles with many others providing inspiration.

The real medical peeps appearing in the video:

Attendings: Dr. Dave Hart, Dr. Michael Blackstone, Dr. Christine Estrada, Dr. Hide Shigemitsu

Residents: David Cotter, Keith Ebilane, Casey Muir, Iris Nagamine, Dulip Ratnasoma, Phil Ribeiro, Usama Siddiqui, Thomas Tsai

Pharmacy: Russell Kirkham PharmD, a recent graduate of Roseman University in Vegas.

Photo credits (submitted by fans on Facebook): Amanda Curtsinger, Monica Tran, Holly Leider, Amy Goodman-Rivas, Jessica Bechtel, Stacey Gallamore-Horstman, Stacy Robinson, Christine Estrada, Athenahealth

Special Thanks to Dr. Bob Wachter for sharing with me the great EHR chapter from his new book, The Digital Doctor.



Get ZDoggMD to come speak in YOUR healthcare ‘hood!

First Verse:
Yeah I’m out that paper, no more chasing med records
Writing so illegible, that I’ll be HIPAA foreva
Bought the new software, and though we use it here
I can’t use it over there, different systems everywhere
I used to chart on paper, all of my verbals recorded
Mix up with the ward clerk, turned “diluted” to “dilaudid”
Switched me to that EMR, meaningless abuse, G
Now catch me at the nurses station mashin’ that F2 key
Notes used to be our story, narrative, but yo
Replaced with copy paste, now a bloated ransom note
Me, I’m at that bedside, focused like a laser beam
On the patient, naw come on, I’m treatin’ the computer screen
8 dozen warnings, click check boxes
Alarm fatigue, vaseline conflicts with doxy??
Nurses they be burned out, we could use some OT
Tell by our wrist guards that we most definitely on
First Chorus:
EHR, crappy software some vendor made us, there’s nothing you can do, stuck with EHR, best practice pop ups will tire you, complain and they’ll fire you, we need a new chart new chart new chart
(you’re welcome, they built you a turd doc!)
Second Verse:
Catch me on the phone with IT beggin’ tech support
Shoot, it’s like IT and me be stuck in 1994
Innovation all around, but it ain’t in healthcare
Internet and apps for you, but we get ancient software
Welcome to that EHR, Go Live and it don’t stop
Uncle Sam promoted it, but gone is the interop
CMS, EMS, PMS, holla back
For doctors it ain’t fair, these vendors act like they all kinda wack
8 million stories, out there docs can’t take it, after this disaster half of y’all won’t make it
How to train your Dragon: “hotmail” isn’t “Hot Male”
If some be saying it’s epic we sayin’ it’s epic fail
Electronic silo, team not talking
Paperless they say, but whole trees we droppin’
Props to case management
Long live the RT
Long live the pharmacist, whole team definitely hates
Second Chorus:
EHR, just a glorified billing platform, with some patient stuff tacked on, give us a new chart, ICD-10’s a disaster, meet your new robot master, we need a new chart, new chart, new chart
(this chart wack, welcome to the apocalypse doc)
Third Verse:
Tech should bind us, connect, not blind us, to the reason why we care,
Patient’s face reminds us
Designs like Epocrates, that tap the app agilely
Then magically the team works, let’s bite the Apple, Steve
Caught up in the in-box, now you’re in-sane
Good docs gone mad, the clinic’s filled with them
Nursing, they the heart of everything
Data entry got ‘em hurtin’, life starts when the shift ends
10 years of school, graduated to the OR
Mommy busts a Whipple she deserves a better damn chart
Autocorrect turning Chantix into Champion
Patient needs a sleeper, 30 clicks for a Ambien
Third Chorus:
EHR, crappy software some vendor made us, there’s something you CAN do, give us a new chart, stand up and make our voices heard, let doctors be doctors, we need a new chart new chart new chart
(Stand up, the whole team)

72 Responses to “EHR State of Mind”

  1. Deanna Powell

    Another awesome video. As a RN 1st (I started in paper charts) and also as an RN who works in the quality and healthcare improvement dept, I can completely understand your frustrations. I see it on a routine basis. I ???? Your videos and your messages. Keep up the good work ZDogg.

  2. Dr Dave

    As always a superb video Dog!! \nToday the mess is so bad that the EMR is the number one time consumer in our day more then Pt care and conferences and the like. If I wanted to be a billing coder I would have gone to school. ALL we have is a billing system the rest is just a huge extension of the Legal department’s agenda only extrapolated to end provider for implementation. These ALL were created as primarily a billing product then legal defense/litigation/monitoring for fraud product then a provider “march in step” product and finally a patient record system but by then it has no value left\nWe need to step back determine our priorities and start all over again. NO tweak will work this needs a start-over with ONE standard like ASCII or similar then build from there so everyone can work on anyone and billing can do their job, and legal can do theirs, we will do ours but this “I can do it all” nonsense has to stop.\nDr D

  3. Stacey Gordon

    It is deliberate that a barrier is placed between doctors, nurses and patients. It’s a gradual way to get people used to the healthcare personnel being completely replaced by computer/screen. No eye contact? Good, get used it. They want to eliminate the narrative. They want to make it inefficient for you to pick up the phone and call another physician. We are all beta testing the billing/legal portions of the eventual, fully remote, tele-medicine system. It’s not a problem, it’s the goal. 30 clicks for an Ambien will drive an intelligent person mad. But a government employee diagnostic technician, not so much. That’s right. Soon, no such thing as a doctor/physician. Medicine will rely on diagnostic techs that read from a protocol/script/algorithm. Insurance companies will meet the EHR companies half way and demand this. Why else would this be happening?

    • Holly

      Here Here!

  4. Robin Wronski

    Brilliant!! \n

  5. Michelle M

    30 clicks for a Ambien! Funny, sad, true!

  6. Kathi Bushnell

    As a medical transcriptionist, I have always been proud of my part on the team. Physicians and other healthcare providers are pulled in every direction by insurance companies, hospital admin, and every governing agency with nothing else to do but make trouble and come between the provider and the patient.\nOn a daily basis I correct “mg” to “mcg”, correct gender identification, ages, right/left discrepancies, etc. The providers are too busy to be bogged down writing notes. That’s what we have always been here for, to help the provider produce a clean, coherent, error-free document under the correct patient’s name. Now our work is either converted to EHR, placing the onus on the already overworked providers, or offshored. Having seen some of those notes, I am appalled. Our pay has been cut in half “because you can produce twice as much with voice wreck.” In what universe? It takes more time correcting “train wall to crush abdomen vegetable” than it does typing it correctly in the first place. \nHaving had my rant, kudos on the video. It takes a massive effort to get me to smile after a full shift of horror, but this video make me wish I had a Depends on. Gotta go shower.

      • Stacey Gordon

        hehe. words.

  7. Jan L

    Another MT (medical transcriptionist) here, and I totally agree with the comments from the fellow MT below. I am lucky enough to still type reports from scratch and not have to deal with editing the notes voice wreck has attempted to produce, and failed miserably. I also change mg to mcg, left to right, realize when a medication is in the med list, but also in the allergy list, make sure the patient name dictated matches ailments from prior reports, and countless other mistakes that slip through the cracks. I strive to upload the best, most cohesive medical record I am able with the sound file provided, with bolded “flags” for you to read/correct when there is a discrepancy. I care. I am 99% sure most people don’t give their medical record a second thought, but it would be nice if they did, and asked for a copy before leaving the office.

  8. Dawn Athey

    Yet another brilliant video with a message that hits home. As an ER Nurse, its frustrating to spend more time charting with point and click that isn’t appropriate. And precepting new graduate nurses who get more caught up in charting than in actually caring for the patient. No wonder our Press Ganey scores are in the toilet. We need a more efficient charting system for all healthcare providers that allows more time at the bedside, where we belong.

  9. Lisa

    Nice! There are many ascepts to the EHR that I love – for instance being able to see notes, vitals, meds, etc given when the pt was just at another visit or the ED within our health system. BUT, I spend an incredible amount of time in my day making sure all the boxes are checked, codes correct, all the compliance stuff is done, etc etc etc. I realize it has to be done but it is beginning to be overkill – Let Nurses Be Nurses too!!

  10. Deb Smith VanZytveld

    Umm…we’re still using paper charts, assessments and orders. (hides) 🙂

  11. Amy

    Who is the “they make us do this?” that everyone is talking about? Healthcare IT here, and while I work more on the patient access and revenue side than with clinicians, I would say the majority of times I can’t streamline something my users are asking for, it’s because it breaks a CMS requirement (causes denials) or would end up with a ding on a Meaningful Use report. That’s not the EHR, that’s the government entities enforcing all of these things and those of us supporting it being forced to take a hard line on taking things out to protect the healthcare organization’s backside. EHRs on their own are a good thing, the problem now that so much can be stored discretely in a database, it can be reported on and recorded, so we’re now required to do it because the EHR really shines on a light on things when we don’t.

  12. Karen Britton Maples

    Love the video. I just wonder if the software companies ever ask for doctors and nurses input prior to releasing their product. If they do, how recent is the doctors and nurses clinical experience. I also agree that the software should talk to one another so when the doctor charts at the hospital, it shows in both the office chart and the post-acute chart. Wish I knew how to write programs. Thank you for representing both physicians and nurses in your wonderful videos. They are the highlight to my day. \n\nKaren RN

    • A54flo, RN, MSN, RNC-MNN

      No, they ask people with degrees who haven’t practices in years.

    • A54flo, RN, MSN, RNC-MNN

      The sad answer is no. They tout that they have nurses and doctors input but those people are so far removed from the bedside that their claims are ludicrous.

      • Karen Britton Maples

        You are so right. No wonder our EHR is archaic.

  13. A54flo, RN, MSN, RNC-MNN

    There is SOOOOOO much truth in this video. The EHR is an EPIC fail on every level. All bedside staff know it, live it, and struggle to provide care in spite of it. However, those behind a desk (with beverages at their fingertips while their staff become dehydrated because all beverages are now banned anywhere they’ve deemed a ‘patient care area’) refuse to acknowledge that there even IS a problem. They’d rather develop any number of jackass ideas behind closed doors, in secret, with password protected sites so you can’t learn about them until they’re already implemented, and more importantly without any input from those very people who have to work in, under, and through whatever jackass idea they’re now implementing. These same desk jockeys couldn’t provide true health care if their mother’s life depended on it. And it’s a sure bet that if the idea didn’t generate from someone in the trenches, at the bedside, and knee deep in the chaos that has become healthcare today, it probably isn’t going to benefit neither the patients nor the healthcare providers.

  14. Pete Kelley,MD

    I went to the letdoctorsbedoctors.com website, and it is an advertisement for Athena Health’s EMR requesting my contact information. I entered bogus information in order to see their “3-minute demo”, and it is the same old vaporware dog and pony show. What’s up with that? Why are you endorsing Athena’s EMR?

    • ZDoggMD

      Hi Pete, let me clarify something: I in no way endorse or promote athenahealth’s EHR. In fact, I haven’t even really seen it or worked with it. Athena helped me to pay for some of the production costs for this video (which I was making anyways) and I agreed with their hashtag campaign #letdoctorsbedoctors. I also liked that they were the first to admit that their own EHR needs improvement, and they are trying—particularly on the interoperability side. The LDBD website itself is hosted by athenahealth and does indeed contain links to demo material for their EHR. But it is also a public forum to leave comments that everyone can see (with any contact info you want to leave or not) and people are free to say anything there, including bashing athena’s ehr. Those comments will be brought to policy makers and will also help shape future EHR offerings. It’s that platform that I support. I hope this clarifies a bit, let me know if you have other questions. Don’t worry, I’m not going Dr. Oz and selling out on you…yet.

      • Pete Kelley,MD

        Thanks for the explanation. I figured that was the case. I enjoy your videos and I applaud the effort on EMR’s. However, I doubt that random complaints posted on that site, whether taken to Washington by Athena or not, will help matters much.

        • ZDoggMD

          I hear you Pete. But something is definitely better than nothing in this space! Thanks for giving me your take.

  15. Ursula CCS

    As a medical coder I can assure you we don’t want the doctors to have to waste their time clicking ICD-10 codes in place of simply free texting their diagnoses. I have argued and argued against it. We don’t use the codes our physicians are forced to input 99% of the time because the physicians don’t know (and understandably don’t care) about the multitude of rules to govern coding. My docs get so frustrated they go straight to the unspecified codes and I have to determine what they meant to say from what they were allowed to type in. And don’t even get me started on dictation programs! Replacing our medical transcriptions with voice recognition programs has been another bane of the healthcare system. Give me handwritten or typed physician notes any day! If it’s any consolation, coders hate these things as much as you do. However, ICD-10 is a good thing as it allows us to more accurately portray what you guys do, it just shouldn’t be forced on the clinical staff to do the coding, that’s what we are for. 🙂

    • ZDoggMD

      Thanks for your perspective Ursula!

  16. Nathan Call

    Hey yo ZDOGG, that was flipping brilliant bruddah! Get us back to the bedside instead of clicking boxes! \n

  17. DrGBach

    EPIC Acronym of the Day SNEFU (Think SNAFU) Seems that EHRs do not take into much consideration ease of use and functionality for Physicians and other providers

  18. DrGBach

    Ponder this. If EPIC were running Amazon, Apple or eBay would they succeed? How long would they last? \n\nNow think of the converse of that (keeping in mind the Amazon 1 click functionality)

  19. Andrew Boush

    ZDogg, you say everything I want to say, but better. I loved your work before, and your TED talk, but this is my favorite thing yet. The time of legislators who know nothing about health care defining the most minute action of our jobs needs to come to an end, and it won’t unless we make a loud noise.

  20. Weissass

    Brilliant! Simply brilliant. I’m overwhelmed and thankful that others out there feel my daily pain. I friggin’ hate EMRs. You guys nailed it! Can you mock MOC next?

    • ZDoggMD

      Don’t get me started on MOC, I won’t be able to stop myself…

  21. Crab cakes

    Great line…30 clicks for an Ambien.

  22. drkeith

    Doctors not allowed to name medical necessity. Big dog cash hogs took and cooked the recipe. Miss a code they’ll hang you with a rope made of CPT produced by the AMA’s disaster of a strategy. This madhouse of cards is being built on faulty evidence but only docs and patients see the project makes no common sense. Patient centered in their dreams the masters make us wanna scream. They say that’s just the way it is insurers need a thriving biz to keep their patrons in the fizz. A visit with a health care slave is not the way to trim and save. Can’t say we’ll do no harm in system run like a chicken farm. Let doctors be doctors.

  23. DrM

    Great video! The whole EMR debacle just proves that we need people who actually touch patients for a living to run healthcare (from administrators to IT to the law). When mandated content and cut and paste enlarges a discharge “summary” to 14 pages (as written by one of my interns recently), we all know something is wrong.

  24. MT the MT

    I have definitely become a fan, ZDOGGMD. The first video\nthat I saw was the one about end of life issues. Yes, it’s time to start\ntalking more openly about this, I wholeheartedly agree but I don’t want\nto get on a rant about that issue right now. \nI just watched the new EHR rap. First, I’ve been a medical\ntranscriptionist for 33 years; I started when I was 18 years old, and was one\nof the lucky people who fell right into the perfect career for me. I’m\ngood. I’ve had records that I’ve transcribed go to many places around the\nworld and into courtrooms. I was taught old school and the AAMT/AHIMA\nwasn’t around or was just starting when I began my career— but that’s another\nrant. \nI have worked in all specialties and settings for\ntranscription…oh wait, we’re called Medical Language Specialists now. In\nother words, we’ve been given a\nfancy title that is supposed to make up for the loss of income and respect for\nour abilities. Transcribing doctors and healthcare providers’ dictation\nis a talent, a skill, and not just anyone can do it. It is not just\nsitting and typing- it truly is a profession. I used to make twice what I\nmake now and I could get a job in 1-2 days anywhere in\nthe US. Now\nthat I’m 50+, I’m struggling financially and have had to resort to working for\ntranscription services. I’ve also been forced to work 3 jobs just so I\ncan go back to school to change my career/obtain a degree in billing and\ncoding. When I’m done, I will probably make as much or less than I used\nto as an MT plus the added burden of $26,000+ in student loans. Grants?\n LOL. Right. I make too much money.\nI think I can speak for most MTs and say that we would all love\nto go back to the old days too, and let doctors be doctors. I do believe\nelectronic health records are a necessary step to better healthcare, but I\ndon’t think healthcare professionals clicking boxes, training their Dragon,\nlooking up and memorizing codes, and learning 10 different kinds of software-\nthat don’t play well together- is what those providers should be doing instead\nof taking care of their patients. \nSome of you guys and gals can be a pain in our ears, but we\nstill love what we do. It’s not just hearing the right things or spelling\nthem right, it’s knowing what they mean, the anatomy, the physiology, diagnoses,\nthe pharmaceuticals, the surgical instruments, the surgical procedures, and\nknowing how they ALL go together. I love transcribing operative/trauma\nreports because they are very challenging, and in my minds’ eye, I’m seeing\nevery stitch and incision as I type. \nSo, my solution? Let the transcribers transcribe into the\nEHR, give us back our careers and a decent income. Right now MT’s are\nbeing trained, have trained, and will be trained in multiple software\nplatforms. I myself have worked on at least a dozen of them just in the\nlast few years. WE HAVE THE TECHNOLOGY! AND CAN STILL SAVE THE\nTREES! In the scheme of things, we don’t make a ton of money, never have,\nbut we provide and provided a necessary service, had pride in what we do, and\nmade a decent living at it. \nThere isn’t any straight transcription out there anymore, not\nreally, it’s all VR editing and I hate it. I think some of us can type\ndictation faster- I believe more accurately- than we can edit. You\nwouldn’t believe, or maybe you would, what comes out of the VR. It’s\nabsolutely ridiculous, and talk about law suits! There’s a law suit\nwaiting to happen in 99% of the VR reports. Those difficulties are compounded\nwith the ESL dictators. And…get this…editing pays 1/2 of what straight\ntranscribing does. For example, if I made 10 cents a line for straight\ntyping, I’d only get 5 cents a line for editing. Yes, the words are\nalready there but a lot of them are WRONG and we have to figure out how to fix\nit, research the word or phrase so on. We only get paid by 65-character\nlines, sometimes with and sometimes without counting spaces; a space is a\nkeystroke so I think we should get paid for it. Also, those\nreports, most of the time, have to be formatted or reformatted. The only ones\nmaking a decent living from EHR, the way it is, are the transcription services,\nthe software companies, IT personnel, etc. It doesn’t trickle down to the\nones actually finishing the product/medical record, yet we are expected to\nknow, and accurately record on EHR or paper all aspects of the medical record. \n\nI miss the days when I was allowed, as a professional medical\ntranscriptionist, to actually make doctors words look good on paper regardless\nof mispronunciations, misspellings, and inaccurate dosages that sometimes a\nharried doctor dictates. You would think that quality and accuracy of\nthose medical records would be as important as the “style.” \nWe are a lot less expensive, in money and time, to pay than\ndoctors whose time is better spent doing what they do, patient care.\n We’re patient’s too. and even though I am totally and completely, and\nhave always been female, I found I had had a normal prostate exam in my EHR\nrecord! \nPlease, save any comments about my punctuation, grammar mistakes\nor possible misspellings I’ve typed here. This is my free typing and does\nnot reflect my skill as a transcriptionist. \n\nThanks,\nMT the MT

    • ChrisZ6229

      I could have written this myself. MT for 28 years — lost my job a year ago due to Epic and EMR. Editing now done in India — where English is their second language. Think this is gonna be accurate? The patients are the biggest losers — and the providers — once the lawsuits start rolling in. Just let me transcribe again! Or at least edit! I guess that “quality and accuracy” that was the MT mantra for decades in the end really didn’t mean anything, right?

      • Dona Sundeen

        Here, here!

      • Alice

        And my surgeon thought I was joking when I pointed out that my notes were probably being typed in India by people who 100% of the time cannot handle the word “thymectomy” – according to my chart I’ve had surgery to remove a variety of lumps from my thyroid to my left knee!

  25. dr grace gj

    1 national EHR should be the DHHS mandate…healthcare is too important an issue in multiple ways!!! \nThanks Z-Dogg for your very loud voice!!!

  26. debbythenurse

    “Just a glorified billing platform” that says it all. When my patients complain I spend all my time on the computer, I tell them when I became a nurse in 1977, I spent 90% of my time doing patient care and 10% charting. Now it’s the reverse. This is not progress. Home Care nursing is buried in EHR.

  27. Mary Ann Gonzales

    I think these guys should get on your fan page here or FB :)\n\nhttps://www.facebook.com/Upworthy/videos/1070600086314182/?pnref=story

  28. John Frederick Vickers

    this is THE BEST!!!!!!!

  29. Sharon Murphy Dodd

    I love this video. I am a doctor and also a patient. I find it terrible that I have to get my physician in one building hand write a lab order, because the computers in the next building (but the same organization) can’t communicate with the system across the street.

  30. charlesjneilsonmd

    In the emergency room, I find that EMRs have not improved patient care. 1) the physician spends more time feeding the beast in a cubicle and less and less time with patients. 2) As a result of less face to face time, with that time spent revealing an importunate and overburdened physician, patient satisfaction scores have not increased, but rather dropped. 3) The frustrations of having an electronic gizmo that was designed by non physician computer nerds that have no idea of how physicians think, and consequently takes the physician into a time wasting effort only to dead end into routine meaningless quagmires are plenty: Long lists of data base diagnoses with the top of the columns resplendent with rare and unusual terms (like “Secondary Lues” or “Vitiligo”) while the more common diagnoses are waiting at the bottom of a long column (like “Tinea Corpora”) …..or worse, your correct diagnoses are not even listed! Thus wasting a lot of time looking for it in the data base. 4) Both the radiology software programs and the patient care programs shut off after several minutes of non-use requiring the physician to wait to get back online again. Some radiology programs are quite slow in getting back to square one again. 5) Nurses will not perform a verbal order unless the CPOE order is entered into the computer by the MD. But if you place an order on the CPOE and check to see if it was done an hour later, the nurse tells you it would have ensured it was done by having made a verbal order! 6) The people who actually see the patient, interact with the patient, hold the highest risk in preventing malpractice, etc……ie the doctor and nurses …..are the ones dedicating their 12 straight hours to feeding that beast. Never mind that they had no input into the selection of the software program itself. While the administrators and business people work their 8 hours wanting a system that best fills their needs, they have the power to make the workplace for those doctors and nurses such a tedious, unhappy, torturous 12 hours of frenzied and frustrating imprisonment. Gone is the fulfilling pleasant team interaction as the factory assembly line now is separated from one another and all beholden to the beast. The NSA now has access to everyone’s most secret medical history and since this is the bottom line, no wonder that hospital administrators are NEVER seen being indicted for kickbacks and other favors with their selection of the software system for their hospital. After all, they are facilitating this data takeover of the health history of individual Americans. With many thousands of administrators, why are they going scott free? I see Stark laws in existence, along with doctors being indicted regularly, but never one single administrator. If perhaps 10% of physicians are “crooked”, then why are 0% administrators caught taking such presumed favors? You always reap what you sow. Patients, physicians, and nurses are already reaping the whirlwind.

    • ZDoggMD

      What you said. Check out Wachter’s Digital Doctor chapter on EHRs, echoes a lot of what you are saying. It’s truth.

  31. Donna Muscara Hobby

    What can we do to help. Nurses feel the same way!

  32. Donna Muscara Hobby

    What can we do to help!?

  33. Suzanne

    People who love patient care DIDN’T invent this. I give anesthesia- EPIC fail on a 27 inch screen that keeps our backs turned away from the surgeon and patient. A thousand clicks to nowhere but billing and phrase work. It’s sad the millennials are being forced into objectivity and away from the art of caring.

  34. Christopher Schaeffer

    The medical record should become a blog…get back to the narrative.

    • ZDoggMD

      Interesting idea; assuming the data input interface allows for the story to be told efficiently!

  35. Jonathan Abbett

    Do we have any evidence to suggest that legislation can improve the usability of a software product?

    • ZDoggMD

      We have plenty of evidence that it can wreck it!

  36. Mark Patton

    More than a year after news first surfaced that veterans weren’t getting timely access to care within the U.S. Department of Veterans Affairs (VA) health care system, it’s clear that more needs to be done to meet these patients’ needs. In honor of Veterans Day, Joining Forces Wellness Week will take place Nov. 9-13, giving physicians an important opportunity to serve the men and women who have served our country.\n\nUnderstanding unique health needs\n\nJoining Forces Wellness Week, cosponsored by the AMA and 10 other health care organizations, will offer five webinars that give insight into how health care professionals can improve the health and care of veterans and service members. Each webinar is worth one continuing medical education credit and will cover such topics as:\n\nImplications of the military’s service culture for health care professionals\nGenerational differences\nService and resilience among families of veterans and service members\nRegister today.\n\nProviding care\n\nPhysicians are needed in the Veteran’s Choice Program, which allows veterans to see physicians outside of the VA system if they are having difficulty accessing the medical care they need.\n\nThe program allows veterans enrolled in VA health care to receive care from non-VA physicians if they have been or will be waiting for more than 30 days to receive care or live more than 40 miles away from a VA medical care facility. Physicians have responded, but many more participants are needed. Recent VA data shows that about 468,000 appointments were not able to be scheduled within the 30-day time frame.\n\nRead the steps you can take to participate in the Veteran’s Choice Program, or view an archived AMA webinar to learn how to sign up to deliver care to veterans.\n\nRecommendations for improving the VA health system\n\nWhile physicians in private practice are rising to the call for providing care to veterans in need, the VA is getting additional assessments of what improvements it needs to make. A recent independent report found four systemic issues that must be addressed to enable the VHA to provide better, more consistent care to veterans and service members:\n\nA disconnect in the alignment of demand, resources and authorities\nUneven bureaucratic operations and processes\nNon-integrated variations in clinical and business data and tools\nLeaders who are not fully empowered as a result of a lack of clear authority, priorities and goals\nAfter finding these systemic flaws, Centers for Medicare & Medicaid Services Alliance to Modernize Healthcare provided recommendations under an approach that divides the entire VA health system into four integrated parts that must work together to transform the organization: governance, operations, data and tools, and leadership. “Solving these problems,” the report said, “will demand far-reaching and complex changes that, when taken together, amount to no less than a system-wide reworking of Veterans Health Administration.”\n\nThe report delivers a common quote among VA patients and physicians to illustrate the widely varying processes of each VA facility, “If you’ve seen one VA hospital, you’ve seen one VA hospital.” This statement can be turned on its head. Physicians, apply to help through the Veteran’s Choice Program and be the reason that one veteran’s quality of care changes for the better.\n\nBy AMA staff writer Troy Parks\n\nMy response\n\nAs a former VA physician, I must say the following are true:\n\n0. “If you’ve seen one VA hospital, you’ve seen one VA hospital.” \n1. A disconnect in the alignment of demand, resources and authorities- “A bad manager can take a good staff and destroy it, causing the best employees to flee and the rest to lose all motivation.” Team concept is supposed to provide an RN, an LPN or MA, an administrative specialist and a provider for each team, but typically nurses and administrative specialists have more than one team and are tasked with several meetings/wk. In two years, I had a stable team for just 6mo; it only took three mo for them to whip me into shape to provide efficient care for the vets. Panels are typically 110% or more of maximum (900 for NPs/PAs and 1800 for physicians in Salem, but in Maui 800 is considered excessive!) Specialists devise complicated referral processes; no referrals means fewer vets waiting to be seen which improves “performance” ‪#‎s‬. Procedures for referrals are devised locally, so they vary from region to region. In VISN 20, specialists are incredibly difficult (impossible) to access for phone consults. \n2. Uneven bureaucratic operations and processes- “if you’ve seen one VA you’ve seen one VA”. \n3. Non-integrated variations in clinical and business data and tools- 3 separate systems with 2 separate sign ins for charting and a 4th system with another separate sign in to measure provider performance. Yet another system and sign in for electronic messages, usually >100 per day and one more system for electronic communication with vets. Well over an hour a day spent signing in and out of the computers. Lack of provider specific training in these systems makes for a long learning curve, generally considered to be about 2yrs. Now top that off with a 2yr probationary period where physicians can be fired without recourse (see #2) and much shorter probationary periods for non provider management. Health care is clearly NOT the top priority. \n4. Leaders who are not fully empowered as a result of a lack of clear authority, \npriorities and goals- or differing goals and priorities at different levels of management. A stated goal of veterans care, but a priority of meeting numerical goals which are measured from that 4th system rather than from the systems \nproviders work out of, while, at the same time, upper level management gets bonuses based on providers production.\n5. “The Veterans Choice Program does not allow choice and does not serve Veteran’s interests well. The VA could and should simply include ALL Medicare providers as potential choices, after all we are registered with the same US Government already.”- Great idea! which brings up another issue; there is no system for those in the trenches to communicate with those who have any power to change policy or procedure. Typical response to such communication with supervisors is (head nod), Hmmmm; it goes to the next level at the whim of the supervisor and, for providers at the clinic level, there can be 5 or more levels to get thru before it gets to someone who make changes. So how do we get William Pease’s idea thru to someone who can change it?????????\n\nAll this said, working with the vets is the most satisfied I’ve been as a physician! To any vet reading this, Thank You!

  37. Linda Sullivan

    Mommy busts a Whipple, or diagnoses heart disease, or treats a sore throat…whatever she busts, mommy (and daddy) definitely deserve a better damn chart. I love this. Props to y’all.

  38. Veronica

    Such a serious problem- as a lawyer and former nurse practitioner – I can’t tell you how many people are being seriously injured or killed due to erros induced by EHRs

  39. Dale

    The EHR killed my private practice. I’m moving to New Zealand.

  40. Bert Duvoisin

    love this!…. one of our docs was so beaten down by our new EHR a few years back that I had to make a parody of my own to help him with his rehab therapy:

    nZdogg keep doing what your are doing… love it!

  41. Sharon Povroznik

    Well I can speak to both ways of charting, having been in healthcare for 35 years;30 years as a registered nurse,computer charting stinks, I hate it, it’s an understatement to say it takes us away from the patient, the Ile saying treat the patient not the monitor, is a perfect analogy, you are supposed to interact with the patient and not the computer screen, when I worked as a recovery room nurse I had a total of seven different programs to go in and out of to chart on my patient and try to chart on a computer when you have a patient who is crashing, it’s a total fu—ng nightmare, and how about the programs who can’t be written to communicate with each other, somethings gotta give people and once again its the patient getting shortchanged.

  42. Carolyn Hand

    Thank you thank you thank you! I am a Women’s Health Nurse Practitioner and EHR has broken my heart and gutted my art. I am passing this along to th top dog in the organization I work in.\nBut as a P.S.-could you please include Advanced Practice Providers such as NPs, PAs, and CNMs? we are all in this together. thanks.

    • Meg Henschel

      yes please include us,I am a CNM and your rap rocks the truth!

  43. TheGoyWonder

    People wonder, “why aren’t EHRs designed with providers in mind?” I’ve worked at Epic and can tell you why not:\n1. Physicians were on staff, but hard to reach. They were technophiles and barely practicing as others mentioned.\n2. It really is a billing platform with some patient stuff tacked on. Everything useful you see is probably a workaround and one level away from not working at all.\n3. Quality Assurance (manual testers) are supposed to be a surrogate for users, as there is no beta testing. They are intentionally hired without CS background and maintained as laymen with a very lite, monkey-see-monkey-do training. However if they are not lickety-split quick to master the software, they are fired. Quality Assurance ends up being more like Self-Reassurance.\n4. There is absolutely no testing of interoperability. There is however plenty of testing for the several convoluted ways of sharing data between Epic servers.

    • ZDoggMD

      Nice behind-the-scenes insight!!

  44. TheGoyWonder

    Probably the biggest single pitfall of usability is there is no “home” screen for most roles. People are good at getting to where they want from a known starting spot, but using Epic you end up meandering between so many screens that look ALMOST the same, but missing the one thing you want.

  45. disqus_idF7UXOZZs

    Loved the line, “They built you a turd, doc.”\nOne of my favorite ways to start a criticism is,\n”You know, most of what I have to say is positive, but I just have to drop one turd in the punch bowl….”

  46. david gotlib

    Well, I’ve designed and implemented an EHR totally with providers in mind. It’s based on Larry Weed’s Problem-Oriented Medical Record (1968!) but expanded and optimized. Check out konote.ca — this is a social-enterprise project, with our goal to release the core code as open-source. Not just a pretty face on a standard EHR — something completely new.

  47. Bridget Jones - Angela

    As a certified builder of non-named EHR in this post, it’s sad to see this outlook from so many on this board. The EHR system I build is specifically designed to make the patient’s experience the best it can be including the care they receive and time they spend with their clinicians. The blog and the comments below don’t sound like a gap within the EHR itself but, a gap within the teams building the EHR and the clinicians that work with it. I saw comments addressing the lack of quality from non-named EHR vendor and though I agree, it’s not an excuse at my organization. My organization believes our knowledge and experience should be strong enough to not only determine their pitfalls but address and fix them before it’s ever released into a production environment. Team work makes any patient’s care the best it can be. Without EHR the communication unfortunately lacks and the patient suffers. Your IT teams should be taught to think outside the box. Don’t accept blanket statements and canned answers from the vendors but take their product and make it better. If the vendor says something can’t interface, find a way to make it happen. We don’t accept can’t at my organization.

  48. Susan Miller

    As a 30 year veteran coder; I will have to agree…for the most part. What is described above is Computer Assisted Coding (CAC), ie Caca. Let us, the Coders do our job, and let the Doctors, Nurses, and Ancillary Staff do their jobs. With that said, we the Coders will still need specific diagnoses. If it’s a duck, call it a duck, instead off a quaking waddler. Most EMR/EHR must have not incurred real Health Information specialists in their design phases. They should be designed to decrease work, instead of increasing it.

  49. Stephanie U

    EHR is a true hatred of mine, and I’m not a hater! I’m an RN, ICU step down. I’ve seen our unit almost stand still because our system has gone down. We’ve honestly become efficient in both paper and EHR because the system crashing is such a frequent issue.
    I’m a charge nurse and for some ridiculous unknown reason, which I can’t even fabricate, have been included in all IT e-mails. I get a minimum of 5 a day, and the majority of my work inbox is IT fluff. Most of these emails don’t even have relevant information in them!
    It’s not just the crashing and unwanted e-mails. I am a floor nurse too. I take care of very critical patients in a very small hospital. My MDs are just, if more, overworked than me as a nurse. Here’s a typical day at my hospital:
    I get my assignment of 3 to 4 patients, report, assessments, check out morning lab results. Most likely 2 of my patients will need K or Mg, or both, or some other order. I have to hunt down my one MD who is trying to do the same as I am doing, only on 20 more patients… All still critical. So he gives me a verbal order. I look for an open computer; it’s a small hospital, say it’s Monday and EVERYONE is doing their weekly rounds and you have all the admin and managers out too; computers are a hot commodity. I MUST type each order in individually, go through the 6 pages of confirmation for each one, all while Mrs. H in 401 has a K of 2 and is becoming symptomatic. Orders in. Now if I actually did what pharmacy wants me to do and wait for them to see the order, gather the Rx and put the patient’s label on it, and deliver it to me by FOOT because yes it’s still a shitty small hospital, I could wait 2 hours! NO! F*=!#: ÷%;#= NOOOOO! I’ve already spent a dumbfounding 20-30 minutes trying to do the prior steps! BUT now that I’ve decided to “override” this Rx from the pyxis, I need another RN to pull it out! This includes enemas, Tylenol, everything. So another 5-10 minutes to interrupt my co-worker from her workflow, but it’s better than 2 hours. Ok, got my drugs! Only took till 1100 to treat a lab that was drawn at 0500. Oh and this particular day, the lab section of the EHR was not communicating with the result display page in our EHR. So the lab had to track me down and HAND me my lab results.

    Hate hate hate!
    (rant over) #letnursesbenurses

    S.U. RN