A long time ago in a galaxy far, far away…what an uncannily accurate description of how it feels to practice in our very own “modern” health care system. In a world brimming over with exponential tech advances — supercomputer smartphones with user interfaces an embryo could master, an open Internet backbone that connects us across continents and cultures — our health care universe languishes with software that’s the clinical equivalent of a Death Star. Overwrought, highly complex, and insanely expensive, yet ultimately foiled by the simplest weakness: a complete neglect of the Force, that mystical energy field between caregiver and patient. The Empire may have mandated electronic health records (EHRs) to bring order to the galaxy, but the Force has lost its balance — and the Jedi have had enough.

How do we know? Just ask them. As a practicing physician for over a decade, I bore witness to the transition from the Old Republic of paper charts, crappy handwriting, and preventable errors to the new Galactic Empire of EHRs, which brought us crappy cut-and-paste notes and more preventable errors. I saw both the promise and the peril of the new technological terror they’d created. And I witnessed the Jedi — front line practitioners of the medical arts — burning out in droves. In fact, I was one of them. Like 60 percent of physicians, I wouldn’t have recommended the career to my own children. Like 43 percent of doctors polled by the American Medical Association, I believe that the EHR had has made my job much more difficult.

Given that physicians often feel they have no voice, I resorted to a slightly unorthodox mouthpiece: a YouTube parody rap video called EHR State of Mind. Creating it was beyond cathartic (especially smashing all those computers), but the overall message is that EHRs (and all technology, in fact) must above all let doctors be doctors. The video had a huge response, with thousands of caregivers speaking out across social media via the #LetDoctorsBeDoctors hashtag. The comments illustrated the vast scope of Jedi despair, starting with the destruction of the patient relationship in favor of a relationship with crappy software:

  • “Sad to spend my day staring at a screen while people share vulnerable moments.”
  • “I spend more time clicking boxes than assessing and caring for my patients.”
  • “We have lost that intimate relationship with our patients & the art of medicine … Instead, we are turned into robots.”

 

We’re more machine than man now … Doc Vader, anyone?

 

Other comments highlighted the terrible interfaces and inefficiencies that come with current EHRs, most of which are really just glorified billing platforms with some patient care tacked on:

  • “The EMR is built for the billers and not for health care providers. Doctors and patients should be the focus of EMR design, not reimbursements.”
  •  “Technology should make the message more clear, legible and transferable. Patients look at their own chart and do not recognize themselves.”
  • “EHRs were designed to decrease errors. I don’t believe I am making fewer errors. I am simply making different errors.”

 

Depressed and angry yet? We’re not done. Billions spent due to government mandates and your EHR2-D2 unit still can’t talk to the BB-8 droid across the street WITHOUT A FAX MACHINE:

  • “We have two hospital systems in the Rochester NY area. Both use (the same EHR), but different versions and they do not communicate. What?!!”
  • “I can’t sleep at night because I know we’re going to kill someone as our inpatient prescribing systems are not interoperable.”

 

Expensive, unusable, unconnected software that abuses doctors and fails patients — the Dark Side, this is. But there has been an awakening in the Force … have you sensed it? The Jedi are finding their voice again, and are beginning to make it heard:

  • “The EMR that works best is the one that is fluid. It doesn’t have 87,000 tabs. It has what the setting requires and is easily adapted when change comes about. Make that and you’ll change the world.”
  • “EHRs can be a good thing for patient care if WE make it that way.  Doctors need to make this happen, not policy makers. Empower physicians to build our own platforms … to take care of our patients within the EHR. Make the EHR as user-friendly as my wife’s Pinterest app or Facebook.  Look to the current software industry AND physicians TOGETHER to make the EHR work for all.”
  • “Help us help patients.”

 

At the climax of the original Star Wars film, Luke Skywalker turns off his flight computer and pushes the screen out of the way. He is desperate to connect with the Force, to reconnect with the present moment. Why should it be any different in medicine? Technology should enable and enhance the human connection, and then get out of the way. The opposite has happened with current EHRs, and that has to change. No one wants to return to the dark ages of paper charts, so physicians and health care providers everywhere need to demand better usability from our EHR vendors, and more intelligent oversight from government. We need to demand technology that lets doctors be doctors, and nurses be nurses, and RTs be RTs, and…you get the message. Now let’s send that message, loud and clear.

 

Book ZDoggMD to come spread this message in YOUR ‘hood!

  • Lori Anne James

    So true. I got into nursing 26 years ago to make a difference in patient’s life. My hospital uses CPSI which I quickly quipped stands for Crappiest Programmed S**t Installed. Click click click… I want the Star Trek Medical tricorders.

  • Mike Henderson

    We should examine EHR’s like anything else in medicine – is the end result something that matters to the patient. For example, living a longer life or higher quality of life. Perhaps we are assuming that doing everything prompted by some system is going to help, much like a rain dance will end a drought. If we could only move our feet right and sing the right notes, then the clouds will come…..

  • Jennifer Crossbow

    I think there are pros and cons to the EHR discussion. I have come in contact with several patients and inquired on “our ever evolving changes within the medical practices” and here are some of the replies:\n\n1) I no longer have to wait several days for a referral to reach my specialist because they are received on “the computer-ma-jig”. The specialist use to say we haven’t received all the paperwork or I have to wait until they get the referral. This is a lot faster now.\n\n2) If they had “the computers” during Hurricane Katrina I probably would not have to had started my medical care over due to my physician office being destroyed and my doctor passing away.\n\n3)The pharmacy doesn’t tell me they haven’t heard from my doctor’s office as much\n\n4) When I moved to live with my daughter, she didn’t have to go to my doctor’s office and get copies of my chart and they say I have 2 charts because I’ve been with them since forever. Could you imagine having to fax all those papers somewhere. What if I had my medical papers with me and they got lost coming to Iowa. They send all those records through the computer now\n\n5)I am able to send my bp readings to my doctor through a patient portal.\n\n6)My doctor prints me a sheet of paper after every office visit which reminds me what I am suppose to do for my chronic conditions until I see her again. It has my medication list on it too.\n\n7)-From a nurse- I don’t have to look for records on a fax machine or on my provider’s desk with patient telephone communication because the patient information is always available. This has prevented numerous call backs needed.\n\n8)My doctor said he will watch for my radiology report from home and called me to discuss my results after 8pm.\n\n9)From a nurse- The system keeps up with clinical guidelines based on a patient’s age and chronic conditions to allow me to assist with anticipated orders prior to my doctor coming into the room. It will alert us if a patient has not had a mammogram, missed a treatment opportunity based on lab values, and monitor patients which have fallen out of care. This was something very hard to manage in the paper world or require additional staff. \n\nThe cons: \n\n1) Providers would like to spend more time with the patient providing quality patient care. (which was the driven passion to obtain a medical license)\n\nLife is 10% of what happens to you and 90% of how you react to it.- So react to it with changes to accommodate the way you practice medicine.\n\nIt requires team work, a strong IT network, and ability to accept challenges. I have worked with our IT group and assisted with the system being customized to fit the way medicine is practiced per physician. We monitored workflows and developed the system around the regular routine of the physician. A lot of physicians choose to utilize scribes to allow for quality patient care with improved patient outcomes and/or satisfaction reports. The mistake often made is selecting systems which do not allow for physicians to customize to their documentation needs. Yes, systems go down- just like lights. However, someone invented a generator. Invent the processes you need and don’t accept a vendor’s excuse to tell you that something can’t eventually be developed. We have been successful with our MU/CQM/PQRS but we built measures around our patient and clinic needs. \n\nWe invented our “generator”. It starts with leadership.\n\nI sincerely hope things get better for all.