For EMRs, I’ve sure paid my dues,
And I hold it’s my right to refuse
Any system with complicity
With that system, Centricity,
That gave me such a case of the blues.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and, honoring a 1-year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska. Since the pandemic, I worked telemedicine, a COVID-19 clinic, a VA clinic, and spots in Texas, Iowa, and Pennsylvania. This summer, I got rescued from a war zone. After getting down-sized from circuit riding rural clinics, I have taken a position close to home.
In the late 50s, my father dictated his office notes with a reuseable wax cylinder called a Dictaphone. At that time, however, most docs were keeping hand-written records, some on file cards.
In my last year of residency, I clerked (now we would say ‘scribed’) for the dermatologist in Casper, Wyoming, writing his notes in real time.
I still wrote clinic notes long hand in the Indian Health Service, till 1987, although I typed up the first note (the H&P or History and Physical) if I hospitalized a patient.
My private practice used microcassette recorders and transcriptionists till 2006 when we got an Electronic Medical Record (EMR) system, driving one partner into retirement.
Throughout the country, doctors now spend 1/3 more time doing records than they did before computerization, which, effectively, reduced the amount of time available for patient care.
Depending on how you count, in the last 11 years I’ve learned 25 or 26 new EMR systems.
One of my first locum tenens (travel) gigs brought me to a hospital using 3 different systems: one for the hospital side, one for the clinic side, and another previously used in the clinic. They retained the third only for information retrieval.
Two years ago in Western Pennsylvania, I used a system with an identical name to the system I’m learning now. But the vendor made significant changes since, and installation of the system varies widely from facility to facility. Which brings the question: how different do 2 variations have to be for one to get counted as new?
I have used 3 good EMR systems. New Zealand’s national, MedTech32, stands as a paragon of usefulness and simplicity. DoctorOnDemand had a very good proprietary system for telemedicine but they replaced it. MedExpress’s DocuTap worked well and quickly, but I don’t know if they still use it.
One, Centricity, I found so horrible I quit the job, and after that refused employment with any facility that used it.
The system that has occupied this last 10 days rates in the top 40%. Our shop stands on the verge of rolling out systems using cell phones and Artificial Intelligence and might speed up the documentation process.
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