Monday, September 22, 2014

I like MY OSCAR EMR Setup....but I'm getting sour about EMR's as I think about them

Wow.  June seems like just the other day.  I was all glowingly positive about getting an Alberta LAB module done for OSCAR.

Two people have approached me about stated that he has an Alberta Lab module built....but he has disappeared in puff of smoke (no, I was NOT smoking anything).....and the other guy said that he was close, but needed an extra $15k or so.  I pledged my $5k, but I have not heard any further discussion about the matter.

So what's up?

I've been thinking about this whole EMR thing and I have to say - I've become disenchanted about the whole EMR concept.

My disenchantment towards EMR's came as a surprise to me.....after I followed an esteemed 85 yo colleague around for a bit at his busy and thriving rural practice.

The practice was a model of efficiency that was "time warped" back to the 1950's.  It was clean, neat and extremely efficient.  This old fellow had an EMR in the office - but he had never seen it.  His office was very modern - even including the XM radio channel that softly played through the waiting room for the sakes of his patients.  He knew what XM radio was, but he just didn't really care to know much about it.  His office manager organized "all that stuff" for him.

I have not chased an Alberta LABS module for OSCAR as aggressively as I could because I don't see much real benefit to it anymore.  Alberta has a really good EHR now, that I can simply keep open in another browser window on my laptop.  I can very easily do a patient search on the EHR and get any labs that I want at any time.  Also included is all LAB/PATH/DI/CONSULTATIONs as well as DRUG Hx on Alberta's Netcare.  I can easily copy/paste anything into OSCAR.

The only thing that I am missing is the ability to analyze patient populations in order to conduct population health how many diabetics do I have that require optimization of their meds due to sub-optimal lab results.

At the end of the day - while it would be good for patients if I could have this functionality.....I would have to undertake that work at my own personal cost in terms of time and income.  There are no rewards or remunerations for Physician in Alberta to do population analysis and health optimization.  This is clearly stupid - but we have a health care administration in Alberta that is not known for its cleverness and efficiency (quite the contrary).


At the end of the day, it seems that the "Real" purpose of an EMR is to download menial clerical activities to Physicians in order to waste their time and expertise.   In the old days of simply dictating a note and having a Nurse follow me around to make notes and chart discussions - we used to be a LOT more efficient.  The use of EMR's in the hospital and clinics by Physicians has probably contributed to at least a 50% deterioration in Physician efficiency.  

This elderly Physician that I followed around for a couple of days literally blew me away with how efficient he was. He rarely looked at a piece of paper and he was totally 150% focused and concentrated on his patients. He missed absolutely nothing.....from the slightly crooked crease in a Mom's ironed slacks (clued him into the carpal tunnel disease) the subtle lack of attention to "normal" makeup and hair styling in a young lady (trying to secretly battle a suicidal depression). He had time for everyone and carried himself through medical interview after interview with an unhurried regal dignity that I have promised myself to emulate as much as possible as I modify my practice to mirror in like over the next couple of years.

His staff followed him from room to room and they made notes, looked up labs and handed him information on a tablet - all in a seamless ballet of medical astuteness, efficiency and ultimately - caring.

Most "modern" Physicians that have never practiced "the old way" could not fathom the cost of having a full time nurse and transcriptionist follow them around all day long.  Now, such Professionals would cost us about $80,000 for the nurse and about $50,000 for the transcriptionist.  This translates to about $550 per day in increased overhead costs (a 400% increase from what the same services would cost only 25 years ago). Almost all EMR's are a bargain compared to this.....except that they totally ignore the value of a Physician's time.....which is about $4000.00 per day.  EMR's easily waste about 20% of that time and so they real cost of an EMR is about $800/day.  Probably better to hire a full time Nurse and Transcriptionist at only about $550.00/day!

Yes, you may argue with my figures...but you would have to argue proportionally if you want to challenge the above'd still lose the argument "for" EMR's.
Sorry to blather!  I've just been feeling frustrated in poor EMR design over the past couple of years.  You should see how I use OSCAR....I maximize the "awesome" in it and totally ignore the "time wasters" in it.  This approach has probably doubled my efficiency and income.

I am going to gradually transition to having more staff in the office to undertake more of the clerical tasks that OSCAR is trying to assign to me.  I will dictate notes into OSCAR via voice transcription, and I will write Rx's using OSCAR's prescription module.....but I think that will be it.  The rest of everything OSCAR can do will be delegated to other staff.  I have started to miss my patients behind the fog of the computer screen and I want to get back to them.

Wish me luck.


  1. Hi John, I understand some of your frustrations with current EMRs. However Oscar12 in Ontario, with integrated billing, HRM, OLIS and Dragon for dictation saves me 20% in time compared to pre-EMR. More time for family, and for patients.
    Dr. Duncan Rozario

  2. Hi John, I share your concerns and just today have sent out a challenge to all Optometrists and Ophthalmologists to help "fix the vision" of EMR or EHR software. The challenge is to address your concern of how digital records to date have impaired the Dr/Pte relationship by putting a keyboard, monitor & a workflow that interrupts eye to eye contact, reduces focus on the patient, and usually takes more time than pen and paper.

    There is a reason 1 million iPads were sold the first day Apple put them on sale. Prior to a tablet (the same size and weight of the clipboard I have used for years) all digital devices cost the Dr time or money and privacy if a scribe was used.

    Most health care records can be entered faster than by pen and paper using a "single tap" entry. I will post a video of this on the website. Complex and Detailed findings can also be handled via smart tablet software design, with pictures and audio recordings to complement. All easy to do with an iPad or well designed tablet that can host a browser.