When The EMR *Is* The Problem

The other day, I sat in an office while a nurse practitioner entered data into an EMR.  The visit was a follow-up, so there wasn’t a lot to record, but somehow, it took a good 45 minutes nonetheless.  While the nurse’s long stenciled fingernails couldn’t have helped her typing speed much, the real problem seemed to be the EMR, which kept locking up and seemed to be harboring someone else’s data. (It had my weight at 50 plus pounds more than I am, a data problem to be avoided if you’re hoping to track patients for health risks.)

Now, I do think some of the responsibility for the crazy quilt of mistakes and processing problems can be laid at the feet of the nurse, who didn’t seem particularly well oriented to the system and as noted, clearly couldn’t have passed a high school typing test. I also doubt she had to mispronounce my name three times as she moved from one screen to another.  Clearly, she wasn’t big on bedside (office-side?) manner.

The thing is, I think she wanted to be helpful, wanted to be personal and most importantly, wanted to be careful with the interview and med prescriptions. The problem was, she was so embedded in the process of using the EMR that the higher purpose of having it there in the first place was all but lost. Though she seemed bright enough, the nurse had trouble compensating for the demands of the system.

The bottom line, as I see it, is that even if the nurse will never win any IT prizes, the situation was not her fault.  It was that the EMR absorbed all of the nurse’s attention and concentration, leaving me feeling somewhat peripheral to the situation at best. Yes, she could probably make some improvements in how she interacts with patients, but if taking her eyes off the screen means she forgets critical details, that’s not going to happen.

This experience left me wondering: How often are good clinicians being turned into distant, vexed and struggling professionals who barely acknowledge that the patient is there twiddling their thumbs?  And how can the health system afford this kind of timewaste and error-prone user patterns?  I don’t know the answer to either question but I think we should find out.