The Tyranny Of Electronic Medical Records - A Cry From The Heart For Improvement.

This appeared earlier in the week.

Our Hospital’s New Software Frets About My ‘Deficiencies’

But the patient records system, called Epic, has a few shortcomings of its own, including a voice that amplifies the insecurities that come with being a doctor.

By Emily Silverman, M.D.

·         Nov. 1, 2019

We had been waiting for this day for years — the day our hospital in San Francisco would shed its antiquated electronic health records system in favor of a more modern alternative called Epic, which has been, or will soon be, adopted by many of the nation’s top medical centers.

Our hospital was full of strangers in turquoise T-shirts, called Epic Superusers, who provided “at the elbow support” for the staff, there to usher in the “death of the legacy system” (as the administrators’ emails put it) and the birth of a new, well, epoch.

But on a recent Monday morning when I logged into so-called Epic Hyperspace for the first time, I was greeted with a pop-up box and an urgent message: “You currently have deficiencies that are either delinquent or will become delinquent within one week. Please complete at your earliest convenience.”

I blinked. The words on my monitor were thick and black on a background of rich mustard yellow. On the left side of the message was an exclamation point inside a circle. Today was my first day using Epic. Had I already done something wrong?

I looked around. There were no turquoise people in sight — our workroom was cloistered in an older building, a long walk from the Superusers.

“You currently have deficiencies.” The words seemed harsh and punitive, and brought me back to middle school: The student dean, reading my name aloud at assembly from a list of students “in trouble” — in my case, for having hidden my crush’s backpack behind a wall in an ill-conceived attempt at flirting.

My English teacher, giving me detention — the only one of my life — when the hem of my shirt inched above my waistband as I reached for a high shelf. My mother, glaring at me in the car when I realized I had left my Samsung flip phone under my seat at the theater.

As a child, I wanted to be good. I wanted to be safe. I wanted to be loved. As an adult, this message was making me feel bad.

I have friends who work at Facebook, writing prompts, reminders, buttons. They talk about voice; they want Facebook to make its users feel a certain way. I understand this. Facebook’s voice, at times, can make me feel cared for, with joyful birthday reminders, old photos resurrected with messages of nostalgia, and words of condolences when a Friend has died.

My hospital’s “legacy” electronic health record system was too disjointed to have a singular personality. Throughout the day, one had to operate many software programs at a time, toggling between screens and tolerating maddening lags. Using it felt less like having a conversation with a helpful colleague and more like standing in a hellish echo chamber of dissonant voices. From the ’80s.

Hence the hospital’s decision to switch to Epic, commonly viewed as the least imperfect of several imperfect electronic health record systems on the market.

As of 2018, all 20 of U.S. News’s “top rated hospitals” were using Epic or had signed contracts to do so. It’s a single, centralized system, and its ubiquitousness makes it easier for doctors to see health care data from other institutions. Its graphics feel modern. It’s customizable.

But Epic has downsides. Many physicians have written about its overwhelming complexity, with a dashboard — encrusted with scores of buttons, switches, lights and levers — that feels like the cockpit of an airplane.

There are the unintelligible medical notes, filled with ragged vines of superfluous, robot-generated text. And Epic makes abrupt requests, mid-documentation, to “assign” patients diagnoses from a list of highly specific options. “Walked into lamppost, subsequent encounter.” “Headache associated with sexual activity, initial encounter.”

It’s an ask that can feel premature, granular and intrusive, especially when symptoms are evolving and clinical reasoning is in flux.

But few have written about the product’s voice. Spot an incorrect diagnosis on a patient’s list of medical problems? Good luck deleting it. Much easier to “resolve” it — a word choice that suggests an expectation of unmitigated success, as if Epic were your helicopter parent.

Checking in on a beloved patient who was hospitalized? Enter his chart and an accusatory pop-up may appear: “Deceased Patient Warning: You are entering the medical record of a deceased patient. Are you sure you want to proceed?” This can be a jarring way to hear the news. But Epic offers no condolences, no empathy, no acknowledgment that doctors, too, have beating hearts.

Lots more here:

https://www.nytimes.com/2019/11/01/health/epic-electronic-health-records.html

All I can say is thank heavens for the Dr Emily's gentle wit and extreme frustration – recognising as she does just how far we have to go to make the use of Digital Health something that is at least supportive of quality practice and also helping the understanding the patient information presented.

If the global market leader is this bad what hope for the rest of the industry?

Really a worthwhile read.

David.