Electronic Medical Records: A Modern-day Tin Lizzie

All new inventions start with fledging prototypes fraught with flaws. With time and innovation they can evolve into the “must-have” televisions, smart phones, and iPads of today. Take, for example, the first Model T. The earliest cars had radiators that froze and exploded in the cold of New England winters. Treadless tires got stuck in March mud and popped regularly from the rocks of country dirt roads. When the auto traversed steep hills, the gas choked off, and the car sputtered to a stop. In short, these early “Tin Lizzies” left many horse-and-buggy owners shaking their heads and saying, “I’ll stick with good ol’ Bessie, thank you!”

Thankfully, after a century of innovation, we now enjoy reliable Toyota Camrys and Honda Accords, and except for the Amish, no one relies on horse-and-buggies anymore.

Remember the party telephone lines of the 1960’s where nosey neighbors listened in on your phone calls or demanded you get off the phone because they had an important call to make? (True confessions: as a little girl, I used to listen in on the neighbor’s phone calls for entertainment! Eavesdropping was fun!) Now I own a smart phone with applications that can direct me to Las Vegas or count my calories!

Did you know Orville Wright’s first Kitty Hawk airplane flight lasted only 12 seconds and soared a measly 20 feet off the ground? Now planes fly at 550 miles per hour at an altitude of 35,000 feet! We’ve come a long way, baby!

Except with Electronic Medical Record (EMR) software.

In 2013, the Rand Corporation performed a massive study of physicians across America and were surprised to discover the number one complaint of American doctors was not their pay, not their long hours, not government mandates, not threats of lawsuits, or even difficult patients. It was their EMR!

And here’s the rub: As of January 1, 2015, Medicare is now paying physicians who still use paper charts (such as myself!) 2% less than those who have converted to electronic medical records.

Not one to willingly throw away 2% of my salary, I recently performed an E-X-H-A-U-S-T-I-V-E search of all available EMRs. I came away disgusted. Why? The currently available programs are still at the level of Orville Wright’s first wobbly Kitty Hawk flight. As I checked out one EMR after another, I kept hoping I’d find “the one”---like a woman finding her soul mate through e-harmony. But so far, all I’ve done is kiss frogs! For example:

E-clinical Works: Too expensive. The 2% penalty costs less than this pricey EMR.

Athena: Since I was friends with two internists whose large medical group had recently chosen Athena, I decided to spare myself the misery of a pushy salesman and call my friends.

“I HATE it!” Dr. Johnson said. “I have to click on a zillion boxes and templates just to document strep throat. My fingers literally ache at night. It takes forever to document the simplest of problems. And a new patient? Pfft! Takes me an hour and a half! Whatever you do, DON’T GO WITH ATHENA!”

Maybe she’s just not tech-savvy. I’ll call my other doctor friend…

Unfortunately, her assessment was even worse! She whispered conspiratorially, “We call Athena the ‘Doctor Killer’ around here. Since management forced us onto Athena, three of our older doctors prematurely retired. Dr. Jones got so frustrated, he flung his computer against the wall and stormed out sputtering, “Life’s too short to put up with this!”

O-kay! I quickly scratched Athena off my list! With a daughter to fund through college and vet school, there can be no early retirements!

Amazing Charts: Amazing Charts got high ratings in my research for being user-friendly. Better yet, my new nurse practitioner used it for four years at her previous job and didn’t hang herself in the broom closet. That’s a good sign, right? Optimistic, I set up a one-hour demo.

Less than five minutes into the demo I found the fatal flaw: a registration process that would force my  receptionist to key in all the patient demographics, instead of allowing the patient to enter the data using an iPad (if they were able to do so.) Thus, my already overworked receptionist would now be required to transcribe all the names, addresses, phone numbers, social security numbers, e-mail addresses, and insurance cards amid answering the phone, scheduling appointments, checking patients in and out, and fending off phone calls from PESKY EMR salesmen who have sniffed out a potential victim. "Why would I sign up for an EMR that ADDED to my receptionist’s workload?" I griped to the salesman.

“Yes, that’s the biggest complaint we get from our doctors…” he conceded.

“Why don’t you fix it?” I asked.

“We’ve been swamped with ICD-10 coding changes and government Meaningful Use mandates,” he replied lamely.

Swell! So the government is happy, but the doctors who pay for the EMR are miserable! Thanks, but no thanks! I’ll check out another EMR.

Kareo: Kareo has ads everywhere touting its virtues, and unlike E-clinical Works, Kareo is affordable. Encouraged, I signed up for yet another one-hour demo. Within minutes, I located the first fatal flaw: To get to a symptom template, I couldn’t just type “weight loss” or “tendinitis” into a search bar. Kareo expected me to scroll through an entire alphabet of medical symptoms (about150!) before I finally reached my desired template. Imagine having to do that 20-plus times a day! It would be like going to Amazon’s website to buy a book, but instead of typing “Wuthering Heights” into a search bar, you have to scroll through the entire alphabet of available books before you finally get to the “W’s.” How many books do you suppose Amazon would sell if they forced their buyers to put up with such a cumbersome design? But that’s what Kareo expects us doctors to do!

When I asked the salesman why their templates didn’t have a search bar, his sheepish response? “Yeah, that’s the biggest complaint we get from our doctors…” You think???

“So why don’t you fix it?” I demand.

You guessed it—government mandates and ICD-10 are taking up all their time! I ended the call frustrated. What about Practice Fusion?

Practice Fusion: This software is free (which I like!) but loaded with ads from drug companies (which I don't like!) Can you spell TACKY? Worse, in 2012, the company extracted the e-mail addresses of the patients in the EMR and sent out physician evaluations that the doctors knew nothing about! Imagine discovering your EMR vendor sent out emails to your patients IN YOUR NAME and you knew nothing about it! Way to build up doctor trust!


I won’t bore you with the inherent flaws of the other eight EMRs I’ve checked out. I’ve about decided my true calling may be EMR tester—like Good Housekeeping test kitchens home economists that check out blenders or toilet cleaners. I seem to have an uncanny ability to find what’s wrong with an EMR in twenty minutes flat!

I'm not opposed to EMRs. In fact, I WANT to buy one! I’m tired of my basement looking like an episode of “Hoarders.” (Physicians are required to keep the record of every patient for 10 years.) I’m tired of losing 2% of my salary just because I still use paper records. But I won’t commit to a half-baked product that wastes my time or costs a fortune. Thus, I will check out EMRs again in a year and hope the “Tin Lizzies” have evolved enough to not drive me into early retirement!