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Yesterday’s Wall Street Journal carried an op-ed piece by a doctor who opposes the electronic medical record. He argued that the time spent entering findings and interventions into the computer detracted from valuable doctor-patient interaction. He also objected to the purchase and implementation time and cost. Dr. Singer focused on the outpatient visit experience from the physician’s viewpoint.

I strongly disagreed. Below is my response, a letter to the editor which I feel represents the perspective of the patient and family. The conversion to digital records is ongoing in many physicians’ offices these days. How do you feel? Does it make the visit less personal or contribute to the quality of information the patient receives? And–will the WSJ publish my response?

Letter to the Editor

I disagree with Dr. Jeffrey Singer’s opinion piece “Obamacare’s Electronic-Records Debacle” in the Opinion section of today’s Wall Street Journal (Feb. 17, 2015). http://www.wsj.com/articles/jeffrey-a-singer-obamacares-electronic-records-debacle-1424133213

As a medical professional with 30 years’ experience in the hospital laboratory and information systems and a current Medicare participant, I strongly support the electronic medical record. Since my retirement in 2008, both my husband and my father have been diagnosed with cancer and I accompany them to all their medical appointments. The patient, preoccupied with the mechanics of the visit such as undressing, changing positions, being prodded, and answering questions, while trying to remember to ask his/her own questions, is at a distinct disadvantage in the patient-doctor information exchange.   The notes which the doctor enters during the outpatient visit provide a valuable portable asset to patient care.  Information entered during the outpatient visit produces not only an accessible and portable digital record, but also a tangible document which the patient can take home.

The very activity of the office visit can interfere with the patient's ability to remember what the doctor said.

The very activity of the office visit can interfere with the patient’s ability to remember what the doctor said.

Last July my 96-year-old and very independent Dad called me with the news that he had what he called “a little cancer” in his throat. He didn’t remember anything else the doctor had said, but the doctor had given him “a paper.” When he found the paper, he read me the words: “non-Hodgkin’s lymphoma.” The term didn’t mean anything to him, but it did to me, and the rest of the report suddenly took on an enhanced significance. We have found that data entry is a part of every office visit, beginning with updating the list of medications and ending with treatment plans and interventions.  We bring our questions in writing and I take notes, but, knowing we will receive a printed report, I can focus on the physician’s assessment and recommendations rather than on recording vital signs, lab results, new medications, and new orders.

Navigating the medical information maze can be daunting.

Navigating the medical information maze can be intimidating.

Most of the information on the patient summary we receive is not put in by the physician personally.  The physician assistant updates the vital signs, medications, and allergies, giving the patient a chance to communicate additions and corrections; the information system itself updates the lab results and maintains a list of existing medical problems; the physician reviews the record and enters an assessment, care plan, and interventions. The patient can take the document home and it is immediately accessible to his/her other health care providers (admittedly an ongoing project, see “A Common Language” on page R5 of today’s WSJ). http://www.wsj.com/articles/electronic-medical-records-get-a-boost-1424145649#livefyre-comment

In my experience, doctors generally handle the data entry phase of the visit with skill and tact. They examine the patient, ask and answer questions, and then turn to the keyboard for a few minutes, often looking up to ask another question or two.  Although we, patient and family member, are quiet during this phase, it is nevertheless patient-focused. Any writer will recognize at once that writing itself is a way of processing information, giving the doctor a chance to assimilate the findings and ask additional questions while the patient is still there.

The Medicare-eligible cancer patient often lives with a variety of concurrent medical conditions and the variety of specialists seen in the course of their treatment can be daunting. The electronic medical record helps both the patient and the provider to coordinate the patient’s care not only with physicians but with other caregivers as well. My father is in an assisted-living residence, and the printed report enables me to make sure his caregivers there have updated information about his condition and medications.

Having a portable legible printout of the patient visit can be comforting as well as useful.

Having a portable legible printout of the patient visit can be reassuring as well as useful.

I realize the implementation of the electronic medical record is expensive and burdensome. But, once in place, I am convinced it contributes greatly to quality patient care and the ability of patients to take ownership of their medical program. Since Dr. Singer specifically addressed outpatient care, I won’t enter on a discussion of inpatient electronic medical records, except to note that my experience is positive there as well.

Lastly, I want to add that the electronic medical record should not be conflated with Obamacare per se. As Dr. Singer notes, the DHHS started a pilot program in 2008, which means the implementation discussion at the federal level started years before that. We were working on it in the hospital even a few years before I retired.

I do not wish to enter into what Dr. Singer calls “The wider ObamaCare debate.”  We may find plenty to agree on there.  But I believe patient care improves with a legible, portable, and accessible electronic medical record. Let’s not throw out the baby with the bath water.

Sincerely,

Gail Marlow Taylor, MT (ASCP), Ph.D.

Coto de Caza, California

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