Big Pharma, Big EMR?

Photo by National Cancer Institute on Unsplash

I understand the argument behind electronic medical records, or EMR. When I was in residency, all of our charts were hand-written on a standard piece of paper. When I took my first clinical job, we dictated all of our charts and they were transcribed by human beings. (Sometimes I mumble or talk too fast and they were quick to let me know.)

One day I came to work and found this note taped above our desk, regarding a chart of mine.

“If it were possible to rate with a minus, this dictation would warrant it; this dictator clips words, chops off sentences and changes thought direction in mid-sentence, leaving intent to the imagination of the hearer.”

Ouch. I got it.

We then moved on to our first ever EMR.

The idea was that it would improve the clarity of our charts, protect us from a medico-legal standpoint and then improve billing and collections. We shopped around and found a decent one and moved on. A few nurses burst into tears the first day we used it, walked out, never to be seen again. Mostly we adapted.

Over time we learned to use voice-recognition software for transcription to enter text into the EMR. It was less than optimal. As one of my partners, from South Georgia, said so eloquently:

“I don’t (expletive deleted) know why this (expletive deleted) program won’t (expletive deleted) understand my (expletive deleted) voice.”

But again, we all powered through. Those of us who labor in emergency departments are nothing if not flexible.

Fortunately I type quite well. In fact, I might argue that typing was the most medically relevant class I took in high school, although at the time I was inclined to be a writer. Medicine came later.

After 20 years in one practice I started to do locums. For the non-medical, that means that I traveled to many different hospitals in many states working to fill in shifts. In the process I learned to use a variety of EMR products, from the simple to the inane.

Currently, my hospital is launching a new electronic system. Not to name names, but it’s one of the biggies. The electronic gorilla in the room. It does collect data well. It does give us access to many prior records within the system.

It’s also click intensive, with a pretty steep learning curve. I’ve used it before, I’ll get it again.

However, what bothers me is the way we were taught for decades that industry was bad. I remember being lectured that I shouldn’t take so much as a pen or a sub sandwich from a drug rep. I was told that industry would warp my young physician mind. It would cause me to make bad decisions about science. It would make me a zombie in the service of what sounded like a vast medical industrial complex conspiracy. Their research was smoke and mirrors and their products created in the service of profit.

Yet here we are. When a vast EMR company, worth literally billions dollars, says “trust us, we’re here to make your life and your patient’s lives better if only you spend most of your time doing data entry” we say, “wow, seems like a GREAT idea!”

Doesn’t anyone think that maybe, just maybe, this is no different from a drug company?

Of course not.

We should have a little more jaded view toward the products, yes, products, that bring their developers and owners the GDP of small nations every year and make us slave to screens day in and day out.

It all makes me miss my little hand-written chart.

Edwin