Doc goes back to paper charts -- for now

By Neil Versel
10:25 AM
Michael P. Jones, MD

Richmond, Va., gastroenterologist Michael P. Jones, MD, is not anti-technology. He just does not like electronic medical records in their current form. He's expecting the technology to improve, but for now, he's opted for paper charts.

"For starters, a lot of the software is clunky and the way it asks for information is unnatural. It can take more time to complete the 'necessary' documentation for a colonoscopy or other endoscopic procedure than it took to do the procedure itself. Doctors and nurses and lab techs suddenly have to be data-entry clerks, filling in multiple 'fields' and negotiating drop-down menus," Jones wrote in a Nov. 24 op-ed in the Los Angeles Times.

Above all, he says, current EMRs are not interoperable, frequently forcing physicians and their staff to chase down records from outside their practices or institutions, just as they did when they still kept paper charts. Systems are not user-friendly, causing overworked physicians to put in even more hours, nor have EMRs fulfilled their promise of producing better care."

"I don't think there's any evidence that they provide better care," Jones explained in an interview with Healthcare IT News. "There's a lot of supposition."

There is much "promise" and "potential" in EMRs, but few have lived up to the hype, he said. "The way it's being used, it's primarily a receipt for a transaction, and exists largely to produce billing documentation. It intrudes on the process of providing care."

Insurance companies "don't really care what happens in an exam room," Jones wrote in the Times. "The visit that you, as a patient, have been anxiously waiting for could just as easily be shoes or oranges or pork bellies to these folks. It's just a commodity. It's just data. And now the industry wants it documented in a format that works for billers and statisticians but not so much for doctors: the electronic medical record," he explained.

"The technology primarily serves the buyer and seller. It doesn't really serve the physician or the patient," Jones said Tuesday.

In the commentary, Jones shared an anecdote about going for care at his own internist's office, not long after that doctor had installed an EMR. "I was pretty stunned, then, when I mostly saw [the] back of his head as he asked me questions and typed, badly," Jones wrote.

"'Hey, Jeff, does any of this look like a good doctor-patient interaction?' I asked.

"Hell, no," was the prompt reply. "But I've got to do this now or I'll never get finished on time," the other physician said, according to Jones.
Jones said physicians spend many hours of time documenting patient encounters after the fact, though he noted that speech recognition could help cut down some of that extra work. "It's also an expense when folks are home doing data entry," he told Healthcare IT News.

"Is it reducing cost, or is it cost shifting?" Jones wondered.

He said that the only real centralized EMR in the country is at the Department of Veterans Affairs. "Why not nationalize that whole thing?" Jones mused, though he did acknowledge that there would be plenty of opposition to a national EMR.

"In theory, an EMR should make care better and more efficient. It's falling pretty far short of that goal," he said.

Jones recently left Virginia Commonwealth University for a small, independent practice, one where he keeps paper charts.

"I feel as if I've stumbled into a medical oasis. My time is spent being a doc rather than a scribe or grocery clerk ringing up a sale," he wrote. "My time is spent interacting with a person who wants my help; it isn't diluted with a perverse treasure hunt for clinically irrelevant but EMR-encouraged information. I'm happier in my work than I have been in a decade. My patients now are happier than my patients then."

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