10 things you hate about your EMR

By Michelle McNickle
01:24 PM

Change is hard. And when that change involves new technology and a radical shift within the industry, it’s even easier to become frustrated. 

The great debate concerning electronic medical records continues to this day, and as more systems are implemented, the more issues providers and professionals have with them. That’s why we asked readers and experts alike to share with us some of their biggest gripes concerning EMRs.

Twitter and LinkedIn were buzzing with issues ranging from usability to an increase in paperwork. From legacy systems to the downright inoperable, we’re seeing EMRs have a long way to go before they’re considered preventative, practical, and patient-friendly. 

Check out the top 10 things you hate about your EMR: 

1. It doesn’t measure up to paper. Shahid Shah, software analyst and author of the blog Healthcare IT Guy, can’t stand when developers and other IT professionals “assume paper records and medical grade documents aren’t as important as structured data.” And according to Deborah Peel, MD, a practicing physician and national expert on medical privacy, EMR systems don’t allow patients to control who can see, use, or disclose sensitive health data. “Today’s EMRs were never build to comply with [patients’] constitutional and ethical rights to privacy,” she said. “This is very different from how paper medical record systems work: where doctors always asked for [patients’] consent before releasing [their] records to anyone.” And when some argue there are many things EMRs can do that paper records can’t, such as sharing information from doctor to doctor, Twitter user @sixuntilme thinks otherwise. “Every doctor has [an EMR], but none of those records talk to one another,” she tweeted. “We need an EMR cloud.”

2. It’s hard to use. Twitter user @LivingWellDoc believes there are many issues concerning an EMR’s usability. “[They] need way more bandwidth than expected,” she tweeted. “[They have] cumbersome interface…[and it’s] difficult to get to certain screens (for example, to make a personal favorite list of prescriptions, have to do so within a patient record).” Twitter user @gemlovesblue also agreed and tweeted, “I hate EHR and validating expense claims. Confusing as hell. I say this with the utmost conviction. #work.” Natalie Hodge, MD, author of the blog Healthergy.net and co-founder and CHO of Personal Medicine, offered a simple solution to making EMR systems easier to use. According to her, all EMR systems should be able to work on a Mac. “There is an inherent amount of costs in Windows-based products because you have to do a million things to make them run,” she said. “People say ‘Macs are so expensive,’ but when you compare the cost of them to hardware in Windows products, Macs are worth it.” Hodge continued by saying many doctors aren’t happy with EMRs, not because of the software, but because of the hardware. “They have multiple pervasive hardware issues that are problematic,” she said. 

3. It doesn’t provide the basics. LinkedIn user David McCartney, CFO at Center Street Community Health Center, has issues with certain systems and their inability to generate basic reports. According to him, the patient accounting module that his vendor is using is “something else.” “My rev cycle coordinator says it’s hard to post money to,” McCartney wrote in response to a question posed by the Healthcare Finance News group. “More importantly, we’re still getting a month-end rev report by the vendor running a database query—there doesn’t appear to be a standard report. And, there is no aged A/R report, either detail or summary.” McCartney explained how he can't graph by the age of the payer to see where problems are. In addition, he can’t estimate allowances for uncollectibles based on ageing. “We’re 13 months into this system and continue to be promised that they’re developing standard reports. I’ve been working in healthcare for 25 years and have never seen a system that couldn’t generate an aged receivable listing.”  Twitter user @aimeecarsonmb has similar issues with her system and the lack of information it provides. “I hate getting discharge summaries from an EMR,” she tweeted. “You get all the details but none of the real info.”

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4. It’s cumbersome. Based on Shah’s experience, it often takes longer to document a note in an EMR that it does to do the same thing in an email editor. “And it certainly [takes longer] than it does on paper,” he said. Twitter user and medical doctor Jacqueline Sequoia (@jsequoia) agrees. “[The] problem lists in the #EMR are being misused,” she tweeted. Sequoia went on say the lists generated by an EMR only create more work for her and her colleagues. Hodge said instead of some systems saving time, they create more steps than necessary to complete a task. “In some old systems, you need eight clicks to do one thing,” she said. “I’ve used charts that were horrible. I would say this to developers, and they would show me how to do what I needed to do but eight clicks later.” Hodge said to fix this problem it’s essential to find companies that understand users are the ones “driving the boat.” “They need to have a willingness to listen so applications can become more user-friendly.” 

[See also: EMR links Montana centers.]

5. It’s ineffective. “It’s nothing more than an electronic typewriter and doesn’t add much by way of clinical improvements,” said Shah. “It doesn’t help me improve my practice, market my services, or monitor my patients’ health in a way as to make it useful on a daily basis.” Peel agrees and took the standpoint of a patient. “When I see my psychotherapist, for example, I am supposed to be asked for consent before my ‘psychotherapy notes’ are disclosed, but most EHRs don’t have a way to keep those notes separate,” she said. “This denies me the right to prevent people from seeing them who have need for that information, like a surgeon or allergy doctor.” Twitter user and medical doctor @JackWestMD noted one challenge with his hospital’s EMR is it ironically produces more paper instead of eliminating it. “One problem with electronic med records (#EMR) is that it's very easy to generate 100s of pages of paper.” He continued by saying most of the time, this information isn’t useful.

6. It doesn’t allow for patient interaction. Hodge said unlike systems that run on laptops or desktops, EHR apps that run on iPhones and iPads allow for a greater amount of patient interaction. “Laptops can take away from the patient, while the iPad adds to patient interaction,” she said. “You can tweak it and show it to the patient; you can show them pictures, videos, and more. It’s not just the experience of charting. It’s getting your experience of charting mixed with patient education.” Shah agrees and added, “I can’t share the notes that I want with patients. My EHR doesn’t encourage or allow collaboration with them.”

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7. It doesn’t protect patient privacy. According to Peel, the business model of many EHR companies is to sell data, and often, they do this without patient consent. “[This] violates the new patients' right in the stimulus bill:  [patients’] protected health information cannot be sold without [their] consent. Further, EHR companies claim they sell ‘de-identified’ data so [patients’] data is still private, but it is impossible to make detailed health data safe from ‘re-identification,’ no matter what they claim.” Peel also said most EHRs don’t encrypt data, and more than 80% of hospital systems don’t encrypt health data either, which violates federal law. 

8. It doesn’t have a viable, rapid feedback loop. According to Hodge, an EMR’s inability to effectively generate feedback that improves the product is an issue. And, she added that feedback should be implemented into the system within a set period of time: 30 days, at the most. “Most hospitals are using first generation health IT, which are these big systems. The only way you can give feedback is to go to a meeting once a year and raise your hand,” she said. “[Giving feedback] is a food-chain process that can take years.” She continued by saying the era of consumer Internet should weigh more heavily on vendors’ minds. “If I have my EMR through an iPhone app, I can give feedback, and two weeks later, changes are made,” she said. “There is a large absence of a viable feedback loop [within traditional EMR systems].” 

[See also: EMR initiative to link independent physicians at El Camino.]

9. It’s not patient friendly. Hodge said it’s important for systems to be iPhone, iPad and Mac friendly not because it’s easier for physicians to use, but also because it’s where consumer demand is. “And that’s where healthcare needs to be,” she said. “You can generate applications that are user friendly. When you talk about portals, it’s referring to patients; you need a system that works like a consumer Internet application so people can reset passwords on their own, for example.” And from a physician’s point of view, patients who log in and upload insurance cards or their old records, for instance, are invaluable. “That enables patients to do more, and the more they’re doing, the less I’m doing, and the less people I have to hire,” said Hodge.

10. It’s outdated. According to Hodge, software that’s written in any kind of language that’s more than four years old is an issue. “If you’re using a system that’s written in Delphi, and a lot of old legacy systems are, then you’re missing out,” she said. “Everything is moving to mobile, and systems should be headed toward HTML5.” She continued by saying older systems can’t allow you to do multiple things at once. “When you’re running off an enterprise system, you can only do some things on the Web,” she said. “And a lot of Windows-based hardware can’t handle that. It’s important to weave an EMR system into your business, and you can’t do that with those big expensive ones that are built into the wall of an office."

What are some of the qualities you love about your EMR?  What can EMR vendors do to avoid frustrating the end user? What can we all do to make EMRs the most beloved healthcare technology?  Leave your comments below and reach us on Twitter @HITNewsTweet.