On electronic medical records and my path to medicine

Imagine one day that you turn on your smartphone or computer, and a completely new operating system has been installed. You fumble through your everyday activities because texting or writing an email is now cumbersome in this new format. This change was not a surprise, though. You actually knew months ago that this was going to occur. You attended hours of training, read several emails and e-learnings, but despite the preparation for this major transition, you are frustrated by your current inefficiency. After the first day, all you want is the old system back even though you know all about the benefits of this system upgrade.

This scenario has happened at almost every major hospital system and clinic in the country as they updated electronic medical records (EMR) systems. In part, due to the 2009 American Recovery and Reinvestment Act, EMR systems have gained traction via financial incentives for early adoption, and conversely, penalties for failing to adopt adequate systems. EMR systems have incredible potential: lowered costs due to unnecessary testing, increased communication through integrated documentation, and heightened patient safety through computerized monitoring—to name a few. Many systems offer patients a more personal glimpse of their own records online, as well as the ability to communicate with clinicians, or request appointments electronically. These benefits at the intersection of healthcare and technology have immense possibilities and as more integration occurs between these fields, we can definitely expect the convergence of these two fields to revolutionize how clinicians work and patients experience care.

However, despite these anticipated benefits, there are several hurdles to installing these complicated systems. First, these systems are expensive, sometimes on the order of tens of millions of dollars, and often take between a year to several years to install completely, depending on the scale and scope of the project. They also involve dozens of staff to implement and then support the system.

Once a new system is active (the initial few weeks are called a “go-live”), end-users generally experience a temporary decrease in efficiency. This inefficiency can be compounded if other departments are going live at the same time. For example, if registration, physician documentation, and radiology systems are all new simultaneously, you can imagine how a slow registration could spill into a delay in physician documentation and radiology readings.

I’ve witnessed this transition first-hand in over 70 different emergency departments (EDs). After I graduated from Northwestern, I provided on-the-job-training and troubleshooting support through a company I worked at called Epic Systems¹, which implements EMR systems throughout the United States. This area of the hospital was probably one of the most chaotic during go-live. In some EDs, prescriptions were not printing correctly, thus old-school prescription pads were temporarily used instead. With the confusion of the new system, patients often had to wait longer to be seen, so the waiting room was completely full of disgruntled patients. Doctors struggled to enter routine orders, and nurses tried to keep up with figuring out what was ordered. To say transitioning to a new EMR system created some very tense situations is an understatement, even if many of these frustrations were expected while learning a completely new system.

As an electronic medical records expert, I know how these systems are configured, and how to troubleshoot the issues that typically arise during the early stages of rolling out a new system. Basically, I know how to do the clinical documentation, without any knowledge of the medical decision-making that is involved. I was doing my own kind of diagnosing, prescribing, and educating in the ED, supporting the clinicians and staff as they treated patients in these acute situations.

The more I worked in the field of electronic medical records, I noticed my proclivity to problem solve, teach, and understand systems. I always had an interest in the sciences, and I was familiar with the healthcare system early on through a family member’s chronic disease. During college, I felt discouraged from applying to medical school due to the increasing difficulty of receiving an acceptance, along with the costs of applying and ultimately, the costs of attending. However, after thinking about my future goals, talking about my interests with the doctors I was helping in the ED, and learning from them as they learned from me, I knew that I had to pursue my dream of becoming a physician. I met a physician who spent several years working in IT consulting prior to going to medical school. It was encouraging to hear about her non-traditional pathway and how satisfied she was with her decision to pursue medicine. So, I took leap of faith, left my job, and decided to apply to medical school the following year.

After enrolling in pre-requisite classes and tackling the MCAT, I was involved in a small research project with a large healthcare organization. My project focused specifically on the geriatric population and metrics in the EMR that might be useful for identifying patients at risk for readmission. Years before, I was in one of their busiest EDs, as they transitioned to a new EMR system. I was excited to get to work on a chart review study because of my work experience. However, once I started doing my chart review, and determined how to do the data collection, I was somewhat discouraged. Being just a research intern, my role did not allow me much access to the more complex features of system. Instead, one by one, I reviewed over 1,000 patient charts, looking for over a dozen metrics for our study such as the patient’s living situation and related fall-risk scores. I worked at a snail’s pace in comparison to what I was hoping to be able to accomplish had I had access to use more complex reporting capabilities.

Through this process, even though I have extensive knowledge of EMR systems, I actually found myself fumbling while trying to find data in the charts. After years of sitting beside frustrated ED clinicians, telling them how to easily find documentation, I was humbled by the fact that it was taking me multiple clicks and repeated scanning of the screen to find documentation that I previously thought would be easy to find. Sometimes information was missing and not gathered, or it seemed hidden in a block of text in a note. Through this experience, I realized that my initial idea of creating reports to extract this data may have been potentially misleading or confusing, or would have still involved additional manual review to fill in the gaps.

All in all, the experience of struggling with a system I considered familiar was an eye-opening lesson that I will keep in mind when I enter medical school this fall. I am eager to see how these systems will continue to revolutionize healthcare and how they will improve and change over my career. Perhaps one day, I will be in a position to leverage my understanding of EMRs and medical knowledge to improve ease of use and efficiency for my fellow physicians, other healthcare professionals, and patients. Until then, I anticipate that as I begin to shadow and do clinical rotations, I will be able to show my attendings and fellow medical students some tips and tricks as the “Epic guy”.