Yet Another electronic health record
I have lost count of the number of different electronic health records I have used in my career. When I started it was only the paper record, the SOAP note, the numbered diagnoses and their associated plans written out in blue or black ink on lined white paper. Don’t forget the jokes about physicians’ illegible writing.
Then in some settings I was allowed to dictate. I remember mastering dictation, the hospital phone line and specific buttons to push to approve, to delete or to listen to specific portions, how to rewind or fast forward, and most important how to save. If I didn’t choose the correct button, I had to start all over again. Notes from medical records arrived in my paper mailbox, no emails back then, and reminded me sign dictations or discharge summaries, the threats if I ignored the reminders and due dates – no more admission privileges. Could they really get along without me carrying my load every third or fourth night?
There was the handheld recorder in clinic, finding the empty tapes to insert, leaving it properly numbered and labeled for the transcriptionist and in the right place. Or needing to recreate lost dictations. Yikes!
The patient charts were held in thin and fat manila-colored folders sequenced on gray metal shelves, volumes for complicated patients. I recall spending what felt like hours paging through the paper sheets to find the details of the most recent admission or surgery or CAT scan, usually the duty of the medical student or intern. The importance of properly listing the surgeries and dates, keeping the Problem List and Medications up to date, especially in clinic charts. I tried to master the organization of the clinic’s medical record room(s) so I could find a chart if staff had gone home for the day or hadn’t yet arrived, and knowing where physicians stacked their charts to review.
I am learning EPIC for the third time. It amazes me to think that as I taking my pre-med courses in Milwaukee, the founder, Judy Faulkner, developed Epic in a basement in Madison, Wisconsin, after her masters in computer science at UW (1979). It was more than a decade later that the electronic record was introduced into our work flows, and eventually mandated with the Affordable Care Act in 2011.
Ms. Faulkner, now a billionaire, has led an inspiring life. She built a successful record covering several hundred million lives, served on the Obama IT advisory committee, married a pediatrician, and raised 3 children, signed the Giving Pledge (Buffet/Gates) in 2012, and has promised not to go public with EPIC.
It is fun to see the changes in EPIC since the earlier versions I used five and ten+ years ago – now even more user friendly. A colleague near my age at Providence Community Health Center, decided to halt her per diem doctoring, not wanting to deal with another EHR. Personally, I see it as a challenge, leaning and mastering new patterns, and I find EPIC intuitive for my brain.
And most of all, I still enjoy patient care. It grounds me to understand the challenges of caring for patients in today’s complex and imperfect system, to see how guidelines change, to be reminded of the realities of caring for patients without health insurance or with translators. And it fuels my passion for training the next generation of health care doctors and clinicians.
While the EHR can blow in a lot of extraneous stuff to weed through when I want to get to the crux of the patient’s problem(s) its use for managing population health issues is a plus. Such as pulling together the panel of diabetics. Interoperability, the ability to share different records from different clinics and hospitals, is still a challenge in the US, thanks to our competitive and legal mindsets. But I wouldn’t want to go back to the paper format I used at the beginning of my career.
Life is change and we muddle forward trying to adapt. I am reminded of the fragility of life and the struggles we all face as humans on this planet for a short time we are here.