Why EMR will continue to be the most hated idea!

Every EMR (Electronic Medical Records System) salesman who tries to sell his merchandise has to go through the most tedious, inconvenient and the least influential person in the process of the actual sale of the software. He/She is that physician who is actually going to use the software. Indeed, the physician is the most unwilling data entry operator of the EMR. So the salesman shows him bells and whistles and bright shiny brochures and colorful screen grabs and assures him the heaven in medical record keeping. As long as he does not elicit screaming from the physician, he can proceed to the next important level of management, taking into his stride some grumbling and impatient muttering from the physician, who clearly did not seem smart enough for his ultra-sleek technology.

During past twenty years, I have used EMR on different platforms starting from word-star, Fox base in the 90’s, C+ in early 2000 till recently the most favored EMR- EPIC. I had also designed a small office-practice software with the help of my talented software engineer friends. That indeed worked very well for me and my group, well, at least for the time being. The best software that made physicians feel happy and empowered were small programs, operated at single site, with limited but essential tools and therefore less clutter on screen and designed around their need. Most importantly they were exclusively – as the name suggests- for Medical Record keeping, and not for Medical Account Keeping.

EMR is a misnomer. It is not medical record keeping system. It is actually Medical Account keeping system. From the point of view of software architect, anything that is not in a box and cannot be processed in Excel sheet is not a data to be bothered about. Doctor’s reports which is actually the most crucial document of his thought process about the patient and his current encounter is just one box, which cannot be processed in Excel. The other boxes- like the insurer, total time spent in visit, level of complexity, medication name, consumables used etc. -are the boxes, that one can work with in Excel. These are the boxes that will ultimately generate big data. Big data will generate trends; trends will help Policy. Problem is, none of these computable boxes capture what is actually wrong with the patient. This computerized medical accounting system helps policy, but does not add any substantial value to actual patient care.

Policy makers, big data scientists and software architects realize this problem. Their solution is to fragment the analogue data of patient care into a digital numerical data. The most prominent example is Pain scale. The EMR screen stubbornly refuses to move to the next level until physician extracts this information from the patient, however annoying it is for the patient, to convert his severity of pain into a number. It is this fragmentation of medical summary from its flowing natural analogue format into digital format of check-boxes, numerical scales and codes that makes a physician extremely weary. It is unnatural, and many times, it does not represent the reality accurately.

EMR- which is actually a medical accounting system, is unfortunately all pervasive and has grown and integrated into the payment and compensation system. The software is built with the logic of industry in mind, where health delivery is a product and therefore all the logistics of capital, raw materials (consumables, labs, pharmaceuticals) is integrated into a sleek logistics from end to end. It serves all the needs and requirements of industry, enterprise and investors. But it does not serve patients as well as it was promised.

The real danger in this is as follows. The expectation from the physicians for fragmented numerical data entry of medical report will keep mounting. The fragmentation will be based on needs of a particular type of data for the policy making. Big data scientists have to be careful about weary and unwilling data entry operators – which in this case are physicians, most of whom do not agree with this project at all. Bad data is only going to give unpredictable and wrong results in the end. The menace of ‘Copy and Paste’ in medical reports as already harming and will continue to imperil retrospective medical research.

Trying to capture health-care delivery by fragmenting into big-data-worthy format is only going to accelerate fragmentation of actual health care delivery itself. This is actually happening, adding to much inconvenience to the patients. The physician community, policy makers, industry leaders, society representatives need to put their mind together and brainstorm what exactly they want to achieve from implementation of EMR.