Electronic medical records, known as EMRs, have been identified as a significant source of burnout for the doctors and nurses that take care of patients. Repetitive clicking for every entry, the task of data entry, the constant logging in and out — it’s made a lot of providers tired, and patients can feel neglected as they tell their story only to have someone type away at a keyboard rather than looking them directly in the eye.

But would medicine be better off if we all went back to paper charts?

When I first started in my career at Straub Medical Center back in 1999, these large files filled with paper were the norm. The earliest entries in the charts were a few lines each, handwritten, by some of the very doctors whose names graced the buildings in which I worked.

Each time a patient came in, a new page was generated. My note was dictated into a phone line, and within a few days it would be sent to my desk for me to sign and correct if necessary. Then it was placed in the front of the chart in preparation for the next visit.

Finding information in the charts was relatively easy, if it was put in the right place. There were tabs for labs, for x-rays, for shots. A place to put any major problems on a list stapled to the left inside cover of the chart.

But things were not always placed in the right location, charts were not always available when patients came in, and medication lists were handwritten by the staff, with variable legibility. Notes took a few days to be typed out by transcriptionists, and weren’t readily available other than in the chart itself.

Taken at clinic
The next evolution of electronic medical records will be more connected to other systems and more transparent for patients. Getty Images

Patients who went to the ER were often left on their own to bring a list of their medications, prior surgeries, etc.

With the earliest EMRs, this improved a little bit. The most recent notes could be read from a server, available after hours and if the paper charts were not there. However, the system still had several limitations. There wasn’t any need for data entry, since the transcribed notes were now computerized, but also not a way to change the notes once they were virtually signed.

Along came a transformative change with the latest version of the EMR. Now, doctors had to enter their own orders. This helped with the accuracy of choosing what they wanted, but also made the physicians’ frustrations rise with the need to do a lot of computer work to get what was once just a checkmark for simple things like cholesterol tests, sugars tests, and more. The numbers of similarly named tests made even the simplest task take much longer.

The notes from each visit were now typed out, or with the advent of voice activated computer dictation, done by talking into a microphone, but with variable results. I will never forget how strange it was when reading that my patient’s spouse was buried in a punchbowl, rather than at Punchbowl cemetery. I knew the nuances of place names, but the computer would have to be trained to figure it out, and that took time I didn’t seem to have.

After 20 years in medical practice, looking back on the evolution of our record-keeping situation, I can honestly say that although EMRs are a source of great frustration with the constant need for documentation, there are so many advantages that for now these outweigh the inconvenience of the old system with paper records. I would never want to go back to how things used to be done.

But there are several enhancements that I hope are just around the corner to make things even better for the patients of tomorrow.

With data entry has come a whole new profession, the medical scribes. People who train to work on the EMR while in the room with patients and providers, so that the notes are done at the time of the visit and no one has to stay late to complete their documentation. Computers should replace this. If I can have Alexa in my living room turn on a speaker, I should be able to have the same interface with a system that can take down notes from patient visits and put them in the chart in the right places.

There should also be a way to have a centralized location for all of the past medical and surgical history that is comprehensive, checked, and verified with patients and providers. In some cases, it’s easy – once someone has an appendectomy, they don’t need to have the details reviewed multiple times, the appendix does not grow back. But if something more complicated has occurred, like a patient having had chemotherapy, a complete list linking what medications were given and the dates should be readily available and confirmed with a pharmacy portal, to avoid any confusion on prior treatments. This is especially important when patients are going to more than one location for their care.

Medical records should be owned by patients rather than medical centers. Right now, there is limited access for many patients, but the best way to make sure someone remembers what was said is to give them a copy of the actual notes from their visits. Any mistakes should be able to be corrected by the patient in the EMR.

Medical records should also be connected so that regardless of the format a system uses, the information can be cross-linked to provide any EMR the same data. This helps avoid duplication of efforts along with allowing each EMR to keep their proprietary programs intact, but doesn’t penalize patients when they see doctors who use outside record systems that are not interconnected.

With the entry of one of the biggest giants of business into the marketplace, Amazon, these technological advances are on the horizon. Change is imminent, and for many providers, it can’t come soon enough. The newest doctors finishing up their training have never worked in the paper system, and when I asked three of my office colleagues, they wouldn’t even know where to begin if the records went back to such a primitive paper form.

Although EMR systems have been identified as a major source of burnout in the medical world, it’s just a transition phase to something that will be even better connected, more transparent, and able to handle the greater demands of the evolving practice of medicine in the very near future.

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