Doing EMRs Right (from a Patient’s Perspective)

As a result of health insurance reform, I am now covered by health insurance, at great personal cost to myself. I chose Kaiser for my coverage because I know and like a number of Kaiser doctors, I like their system (compensation as a salary, not per procedure, which discourages unnecessary procedures and testing since there’s no incentive for it), and it’s convenient. And I have to say that thus far, I have been really impressed with Kaiser — though there have been some billing problems, which are absolutely Covered California’s fault, not Kaiser’s.

One of the things that impresses me most is the thorough integration of electronic medical records into their practice. I can’t speak to what the experience is like for Kaiser physicians and staff, obviously, but I can talk about why it works for me as a patient — and what other health care providers might want to think about in terms of how they use EMRs.

At my first appointment, I had a detailed interview where we went over my medical history, medications, family history, and other matters. At the end of our appointment, my physician refilled prescriptions for me — and they were waiting in the pharmacy downstairs, which was able to instantly access health information through the system to provide appropriate warnings and advice to me. (For example, two of my medications have a listed conflict, which the pharmacist wanted to discuss with me so she could determine if I was aware of the risk and whether alternatives had been explored.)

My doctor also ordered some labwork. I’m accustomed to being handed a huge sheaf of paper and having to go through the whole rigamarole all over again at the lab, but instead, I walked over to the lab, handed them my insurance card, and watched while the woman working at the desk pulled up my information, got me set up, and had me wait for a phlebotomist. Likewise, when I went to renew vaccinations, they could instantly pull up my records, see what I needed, and administer it.

The electronic system has also allowed me to email my doctor, which is so convenient when I have a question or concern but don’t want to bother her with an office appointment and take up time that could be used by other patients. It allows her to triage, keeping patients who don’t need appointments out of the office while moving others in — for example, we handled a skin problem on my face entirely through email. Likewise, I can renew prescriptions electronically and choose to have them mailed to me or delivered for pickup to any Kaiser hospital.

Basically, all the pieces of the system hang together and function hand-in-hand to make my experience as a patient smoother and much more comfortable. I feel confident about how my record is being used, and I appreciate that I don’t get asked the same questions over and over and over again as people fill out different forms or are locked out of part of my record and have to ask again because the system isn’t organised efficiently. (And I notice for the record that Kaiser staff are always very conscientious about following best practices and asking me my name and why I’m there before performing any procedure, whether it’s drawing blood, giving me a vaccination, performing an eye exam, or even taking my blood pressure, to confirm that I’m the right patient and we’re all on board with what’s going on — while I haven’t had surgery at Kaiser yet, I assume the experience in surgery will be similar.)

In the past, I’ve felt really frustrated by EMRs. Often, staff have been poorly trained or haven’t had enough experience — at times, I have been tempted to wrench the keyboard away and handle it myself because I’d be more efficient, and I don’t even know the program. I’ve also been confused about why a clinic or hospital is implementing EMRs if it doesn’t seem to be leading to a meaningful change in efficiency, patient care, or quality of life for people in the workplace. I often see doctors and nurses battling with EMRs and expressing frustration, making me wonder who the system was designed for if care provider and patient alike both hate it.

EMRs are supposed to increase efficiency, reduce the risk of mistakes, limit paperwork, and improve records security. If they’re not accomplishing these things, they should be called into question. If care providers are struggling with them even after the learning curve is accounted for, this is a problem. If patients aren’t experiencing a benefit, clearly something is wrong. Whatever system Kaiser is using, and however it’s been implemented, is working for me, though I don’t know about care providers.

As an early adopter of innovative changes in health, Kaiser has clearly been working with EMRs longer, and thanks to its institutional scale, it can afford major investments in software and training. These aren’t options for smaller hospitals and clinics, which are obviously struggling under the EMR mandate. It’s hard to consider patient experiences when selecting an EMR system, and by the time patients can provide feedback, it’s too late: the hospital has already invested in the system and trained its personnel.

Yet, Kaiser shows me that it’s possible to have a functional experience with EMRs, and I wish other facilities could tap into whatever their secret is, because the thought of returning to another facility makes me cold with dread. As a patient who’s in an out of doctor’s offices a great deal, efficiency with EMRs is particularly important to me; I’d rather not waste half of my precious appointment time going over old news.

Image: in hospital, Robert Couse-Baker, Flickr.