Commentary: Danger, Will Robinson!: We must master EMR navigation without becoming robotic physicians

February 1, 2009

While reading a manual on EMR navigation code lingo for knowing which button to push on a computer to properly use an electronic medical record (EMR), I was watching the recently popular animated movie featuring Wall-E and EVA.

Key Points

Wall-E and EVA represent male and female robots designed for the specific purposes of organizing earth refuse and determining the ability of earth to support vegetation, respectively. It was an interesting juxtaposition of incongruities.

After reading the first 10 pages on EMR, I realized that the goal of this manual was to convert me into a living EVA robot, complete with the ability to convert human disease and suffering into a series of 0 and 1 code assembled into bytes. A noble undertaking, or a trivialization of my life's passion?

What happens to a profession when the basic tenets on which it was founded are missing?

Communication

While I recognize that electronic medical records save trees and decrease waste, I am concerned about the change that they produce in the physician-patient interaction.

Two weeks ago, I took my son to the pediatrician for immunizations. The physician dutifully entered the room, laptop in hand, and sat down on his stool, opening the top of computer and accessing the EMR through his wireless network.

He glanced over the computer quickly and said, "Sorry, the network is slow today. It has been giving me trouble all morning." My son and I dutifully smiled and waited patiently until the system had displayed the appropriate screen before the pediatrician's eyes.

The physician stated he had to update our medical record with current information, and his fingers tapped out a familiar rhythm.

He glanced up again, "What brings you in today?" We recited our list of immunizations and he said, "Wait a minute. I can't type that fast." Again, we patiently waited.

The physician said, "I need to get into a new screen, and I will have it up in just a minute." We waited some more.

Then, the pediatrician announced that we needed a "4 and an 8 and a 12." Great!

The two-page report printed out with this detailed explanation of our visit, past medical history, current medications and action plan moving forward. Amazing - all of this, and we only said 12 words.

From the report, you would have thought we spoke for hours. Certainly, one of the wonders of the EMR! Or, is it?

I am constantly reminded of my ineptitude as a physician. The discrepancy between patient desires and my ability to deliver is huge. Patients constantly ask for a salve to remove seborrheic keratoses or a pill to get rid of verruca or a wrinkle cream that really works. I admit constantly that nothing exists to meet their expectations.

I want to hide under my exam table when the patient retorts, "What do ya mean, nothing exists? You are a dermatologist, aren't you?"

So, what do I have to offer? Perhaps some reassuring conversation or an explanation of the medical problem or a less-than-optimal solution.

Discussion with the patient sometimes helps them to understand that I am concerned, I do mean well, and I can offer a partial solution. I firmly believe, after 20 years of practice, that the conversation during the medical visit is just as important as the prescription I write.

Now, enter the EMR. As I was reading the manual on EMR navigation, I began to wonder where I am navigating in my future as a dermatologist. Am I becoming a real-life EVA robot?