One Physician’s Experience Seeing an Ophthamalogist Pre and Post EHR

I always love to hear doctor’s perspectives on EHR and how they’re impacting their day. You can be certain that they’ll lead with a long list of complaints. Many of the initial complaints are minor things that can be easily resolved with workflow or by a small enhancement by the EHR vendor. Once you get past the initial complaints, then you get to the heart of what they really think about the EHR software. I’ve had this experience hundreds of times and it’s always insightful.

However, this time a doctor shared something even more interesting. This was a doctor visiting another doctor as a patient. Rather than put words in his mouth, I’ll just share with you what he shared with me (EHR vendor name excluded since this could apply to many different EHR vendors):

I was in my ophthalmologist today. He is a really nice, busy doctor. He is in group practice and used to run his wing with one long time nurse with no hassles. He could previously see a patient in 10 min finish refraction, move from room to room and breeze through cases jotting what he needed to write down on one clean ophthalmology SOAP note. Since 2011 they have had EHR Vendor A. (because a consultant sold them on it and promised rewards from CMS)

Today, It took them a total of 1.5 hours to get my refraction, eye exam done. The workflow seemed to be in a complete disarray (remember this is an installed cloud based software since 2011, supposed to the be cream of the crap for Ophthalmology). What shocked me the most was that he now has 4 ladies doing inane things with EMR, trying to help him. I can also see why errors can creep in because he was reading out numbers for the assistant/ Nurse to enter into EHR Vendor A. Distraction fatigue, EMR ennui can cause errors of entry. So the cost of running crappy software far exceeds the physical costs / monthly service costs of the product. It amplifies personnel costs. It took the lady 20 minutes to take totally pointless history and do ROS!

I did not tell her I was a physician and she was clicking away to glory. I counted more than 50 clicks before anything of substance was even gathered. Based on the EMR prompts she made me do finger counting and asking me if I can see her face etc..>! I had clearly indicated to her that I just wanted a retinal exam and prescription for glasses because I wanted to buy new lenses and that I had not required change of prescription for glasses in 10 years!

Then I walk out with mydriatic in my eyes…and saw a hazy illusion of one of my ex-patients, a severe schizophrenic waiting for his turn to be checked in. He was talking about meeting Jesus and asked if I have had a “meeting Jesus moment” in my life.. I assured him I just did…

In those 1 hr and 45 min, the good doctor had seen just 4 patients and 6 more were still waiting impatiently on one arse looking irate, checking their iphones and smart watches …spreading anxiety.

I’m always torn on sharing these type of stories. I know that this doesn’t have to be the case since I know many EHR users who don’t have these issues. However, far too many of them do that it’s worth keeping this perspective in mind. Plus, regardless of how efficiently someone has incorporated the MU requirements, it’s had a huge impact on everyone that’s participating.

I guess it’s fair to say that the above ophthamologist doesn’t agree that meaningful use saves a doctor time.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

6 Comments

  • Don’t have words to describe this post John; I am not here to say this was a fabrication but most certainly a case of exaggeration. Having worked with our EHR from the day we launched to this day – I cannot say that an EHR is so bad that it has made a Doc who used to spend 10 minutes to spend 1 hour and 45 minutes. I think when one is frustrated they probably quadruple the time I guess:)

    I do apply your analogy of Violinist here and can say anything else my friend.

  • Anthony,
    It was 1 hour and 45 minutes where the doctor saw 4 patients. So, that’s ~26 minutes per patient. Plus, he said 10 minutes for a refraction. The other 3 patients might have been something more complex. The larger point was that the EHR had made his ophthamologist much slower.

    The violinist analogy is interesting in this case. I think it’s fair to say that the doctor described here is not an EHR virtuoso.

  • The first EHR I set up a dozen plus years ago was for ophthalmology. I was impressed with how complicated a routine exam can be. Each time you look one way or another is a separate test. In this particular instance, the ophthalmologist was wise to be thorough with an impatient patient who may not have been seen in 10 years.

    Obviously, the doctor in question may not be at ease with using his EHR. However, lacking any information other than that it was “cream of the crap,” it’s hard to know.

  • Thanks for the great article and as an Ophthalmologist and EMR advocate myself, I can relate to this all too well. From 1999 until 2013 I went through several different EMR systems in my private practice with an academic affiliation. I have even lectured in Canada and the US on the benefits of moving to an EMR, always saying that at best you can come close to as fast with data entry as paper but the extra benefits make it more than worth it to use an EMR.

    This all changed for me a year ago when I moved back to the US and am now full time hospital based and have no choice but to use EPIC, or as I often refer to it, #EpicFailure. It sounds like the Ophthalmologist discussed in your article is on EPIC or something equally non-user friendly. As best as I can tell, EPIC and similar systems were designed as Medicare compliance auditing tools and perhaps had involvement of malpractice lawyers. Its main goal is to document absolutely everything possible even if it has nothing to do with the patient in my examining room. EVERY visit at our institution requires such things as a complete review of systems, confrontation visual fields using your fingers just like you mentioned in this article (even if the patient is getting a formal automated visual field test on the same visit), and a grading of any pain they might have and asking them if we can help them with their pain. I realize that this is not necessarily an EMR issue as much as the choice of our institution but nonetheless, it is a phenomenal waste of talented ophthalmic technicians and Ophthalmologists not to mention a waste of time for all our patients. Imagine coming in for a 1 week postoperative visit and having to spend 1.5 hours in the clinic for what should be a 10 minute visit.

    I now have to spend 9 hours per day to see 25 patients, spending ALL of that time either in a room with a patient or pre-entering data in EPIC for upcoming patients. I have zero time to deal with patient phone calls, prescription renewal requests, do any of my former activities like updating my blog, compiling glaucoma articles on my glaucoma subreddit, or breath. Before, still with an EMR but one that was geared toward helping patients instead of creating an audit trail, I would see 44 patients in just 6 hours and still have time to blog, edit my podcasts, etc.

    EMRs are losing their focus. They should be user friendly and geared toward helping providers care for patients. They should help us by suggesting diagnoses based on the data we enter or treatments that are evidence-based to go along with the diagnoses we make. They should be helping us, not hurting us.

  • Ophthalmology is by far the most difficult specialty workflow to adapt an EHR to. Even the doctor who was in for the exam was naive about what must go on during a good eye exam ‘I just wanted a retinal exam and prescription for glasses’. The ophthalmologist would be negligent if he/she did not test to see if the patient had developed glaucoma. I am by no means defending the EHR that was being used at that clinic, although I hope it was not the one I designed. In ophthalmology especially, the effort and commitment on the part of the staff to adapt to the EHR is critical to achieving an efficient and safe workflow. The EHR must also be designed specifically for eye care and only eye care.

  • Doctors need the right EHR, which is designed by doctors for doctors; otherwise, instead of EHR working for doctors, doctors will need to work for EHR. This is not right and this is not meaningful. Every single clicks count when measuring physician’s experience with EHR.

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