Joyce Dobbertin, a physician at Corner Medical, a large rural primary care practice in Lyndonville, is a big fan of electronic medical records. In fact, about 15 years ago, when Corner Medical’s office burned down, she saw an opportunity rise from the ashes, as a fellow physician looked at the flames in horror.
“His tears were coming down his eyes seeing his lifetime dream going up in smoke, and I said ‘this means electronic medical record,’” she recalled.
She figured the office could now make a fresh start, with electronic records. But it wasn't easy.
“A lot of these doctors were not computer savvy and were a little afraid of [electronic records,]” Dobbertin explained. “They had their way of doing it and they did not want to interrupt their way of doing it.”
Eventually, with some cajoling and lots of lunch hour training, Corner Medical did computerize its records.
In her office just before seeing a patient, Dobbertin pulls up a file without showing the name.
“I can quickly see that I need to — in this particular case — talk to this gentlemen about alcohol use and then I can also see if labs need to be done.”
Labs that still need to be done show up in red on Dobbertin’s screen.
For Dobbertin, electronic medical records are as indispensable as stethoscopes. But her friend and colleague, Tom Broderick, isn't convinced medical records have lived up to their promise.
“What the medical record is intended to do is to provide a universal medical record that has good solid standards to it, that’s useful and is totally portable and readable at any place at any time,” Broderick said. “And that has not happened [with digital records] so it has been an experiment on the fly for several decades and it still is.”
Broderick uses a computer in his office, but not in the examining room.
“Most physicians now bring their computers in with them when they are seeing the patient and their eyes and their interests and their attention varies between the computer and the patient,” he said. “I don’t do that. I bring in some notes that I take before I see the patient, because when I go to see a doctor I really want their total attention.”
Full disclosure: Broderick happens to be my physician, so I ask him to find my record on his computer.
After a minute or two of searching, for some inexplicable reason, my record can't be found. Broderick says that happens more then he would like.
But even on a good day, Broderick says data entry gobbles time. When he kept paper records, his typical office visit was about 10 minutes. Now each appointment is 10 minutes longer — to include computer labor — so he can fit fewer patients in each day.
“I am spending more time inputting data into a computer that is not necessarily relevant to making that patient better,” Broderick said. “And I am able to see fewer patients every day. So it’s actually diminished access which is not a good thing.”
Maria Sandoval, an internist and professor at the University of Vermont Medical Center, also used to worry that computers were coming between her and her patients.
“What was very interesting is we had plenty of training on how to use the technology meaning documentation, ordering labs, putting in medication,” Sandoval explained. “But no one even thought about how to use the tool, the computer, in the room with the patient present."
So she and a colleague got a grant to develop a step-by-step manual for weaving computers smoothly into office visits.
"We had plenty of training on how to use the technology meaning documentation, ordering labs, putting in medication, but no one even thought about how to use the tool, the computer, in the room with the patient present." - Maria Sandoval, University of Vermont Medical Center internist and professor
It shows doctors how to position themselves and their screens so that patients do not feel ignored, and advises them to show confidence in the technology. Sandoval always logs out of the confidential record before the patient leaves the room so there is no worry about privacy violations.
Still, Sandoval says, even the best technology is no substitute for eye contact and a reassuring pat on the shoulder.
This piece is part of VPR’s series, Digital Diagnosis, looking at the way information technology is changing how health care is delivered.
