Right tool for the job

First, my sympathy goes out to Dr Greiver: the electronic medical record (EMR) she appears to have been forced to use can only be described as a “dog” if it has been so functionless as to temper her early adopter enthusiasm.¹ To have a query crashing a server is, frankly, pathetic and inexcusable.

Last week I had a patient get lost (another story) on the way to her medical examination so, suddenly, I had a spare 20 minutes. Just that morning, a patient encounter had reminded me that, for multiple reasons, our diabetes tracking had fallen to the bottom of the to-do list. The patient apologized for not following up. I had to apologize to him for not being flagged for recall. So, in my “spare” 20 minutes, I ran a diabetes recall report (no crash) for our clinic group, selected my own patients, sorted them by date of last hemoglobin A_1c measurement (although I could have chosen any of a number of metrics), then started messaging reminders to those missing in action who had fallen off a bit. I was also able to identify those few patients who had moved away and thus “remove” them. I was also able to use the EMR to check which patients had current standing orders at the laboratory and generate new ones for those who did not.

Can I prove that any of this will improve patient care? Like for all family practitioners, our patient populations and the intervention group are too small to show a benefit that will satisfy the statisticians and the meaningful use mavens. So all I can hope is that my EMR-driven, personalized care will maybe help a few of my patients. What I am certain of is that none of this could be achieved so easily with a paper chart system.

As described in Dr Ladouceur’s editorial² that was in the same issue of Canadian Family Physician as this EMR debate,^1,3 the EMR is but a tool. I would not expect to hear anything with a toy plastic stethoscope, but my electronic variety has enabled me to manage the challenges of my hearing deficit. A poor tool foisted upon the end user because it serves administrative or government wants and needs rather than the necessities of the end user (or the receiver: the patient) will continue to engender unhappiness, resistance, and poor outcomes. As the Einstein Internet meme alludes, it is insane that we are still having this discussion and that governments and administrations continue to repeat the mistakes of the past yet expect different outcomes. Personally I would never “go back” from our EMR to the inefficiencies and deficiencies of the paper chart, but, then, the EMR is the system we chose (and switched to) to meet our needs and the needs of our patients, in defiance of government coercion. Our EMRs (and our ability to use them) are probably already a more critical tool than our stethoscopes (think about it: which do we use more in a working day?), so why would we let those who do not actually use them direct which we should use (and how we should use it).

So, I am hoping that Dr Greiver’s enthusiasm can be restored by allowing her to have the right tool and control over how to use it for the benefit of her patients (and herself).

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