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Challenging, unfriendly, time consuming, limited, communications, complications, frustrations, and HELP!   I think all these describe the HIT implementation both from what I have witnessed, from what I have heard, and from what I have read.  But all I really know is what I have seen firsthand from two very different physicians.   Here are a few notes from the two encounters:   

Dr. One

Dr. One has his own practice and is the sole physician in that practice.  He strides into the room with his new laptop balanced precariously on his L arm my chart in his right hand.  It was awkward for him but he finally got settled.  The other thing that was very noticeable was that  he had this microphone hanging from his tie which looked out of place.  He sits down, hits a few keys and announces we are ready.  “Hello” he announces, “I have this new medical record system” so bear with me since I am trying to figure out how it works.  We start to talk a bit.  He stops me and types a few things into the computer.  “I’m sorry” he announces-”Go ahead-you were telling me about the nights you don’t sleep well”.   On and on this goes, i.e. the starting and stopping, as we cover symptoms, medications, and what needs to be done.  Talk, stop, talk, stop, it is irritating that he is mainly concentrating on the computer.   He now has much less eye contact with me.  I sort of feel like the odd man out-so to speak. 

When we have finished our review and he made his recommendations, he stops again without saying a word to me, plugs his microphone into the computer and begins….”The patient is displaying signs of having………..”  He dictates the notes from our meeting and when he finishes he stands up and says his nurse will be back with instructions.   With that he stands up re-cradles the laptop on his L arm, grabs my chart with his R. hand and clumsily slips out the door.  It all seemed very painful to him.  To me, the tool got in the middle of the patient doctor relationship rather than helping it.  But then again, I cut him some slack since it was a new system for him. 

The followup visit about two months later was much the same as the first visit, only the paper chart was gone and the attention to the computer was just slightly diminished.  Progress. 

Dr.  Two

Dr. Two is a member of a treatment team within a large University setting.  I am signaled that something is new by the pretty balloons at the front desk.  “Looks like someone had a birthday!” I declare.  “On no” says the receptionist, “we just went on-line with our new Electronic Medical Records”.  “How do you like it?” I ask.  “It really good she replies, it is so much better than paper charts.  But I do need your picture ID and insurance card so I can scan them into the new system” she declares.  She goes on without prompts “But we are still going to keep the paper charts around even though everything has been scanned into the computer”. 

I think to myself, never hurts to be safe although I personally don’t practice safe scanning, i.e. the policy of keeping papers around for awhile just in case something went wrong with the scan.  I scan everything into my computer and promptly shred the original.  My line of thinking is, if you are going digital, go digital, don’t mess around with halfway measures.  But then again, I am not a big University. 

Dr. Two come into the room and greets me with his usual friendly greeting, we are friends as a result of the painful hours we spent together trying to unwrap the mystery that is my health condition.  I always sit at the foot of the examining table, he sits next to the examining table but facing me, and my wife sits across the room from us.  She is there to remember what is said since I seem unable to accurately recall what I heard just two hours ago.  It is an affliction that I understand is common to most men but in my case at least, short term memory loss is a verifyable part of my disease. 

But this time things are different- the little data entry station that held the monitor, keyboard, and processor would not swivel far enough for the doctor to turn around and look at me!  Oops, someone forgot to check with the doctors before installing the data entry station facing a wall.  He asks if I would mind sitting by my wife since he can more comfortably turn to see me that way.  This was my first clue that this was not going to be a model demonstration. 

Pardon me for failing to mention the redshirts.  These were IT staff people who hang around each department to help it get used to the new way of doing things.  They are noticeable by their bright red shirts, their clipboards, and their general techie appearance.  They lurk in the hallways waiting for a nurse or doctor to have a mental or technical breakdown.  “How long are they in each department?” I ask.   Two to three weeks depending on how many physician’s and staff there were to train.  Cha Ching, that’s gotta cost big time. 

My doctor friend is a young guy- maybe just 30 but already has landed a full time appointment at a Center of Excellence department in a major university.  So he is about as bright as they come, a quality I recognized in him early on in our relationship and part of the reason I asked if he would oversee my care.  He is no dummy.  He struggles out loud with the categories for data entry-what do they mean?  He mumbles to himself, then out loud.  The drop down menus for the IDC code that he is required to enter does not contain my disease.  What to do?  He calls for a redshirt.  There is no drop down menu to help him locate two of my medications’ names.  He calls for a redshirt.  He does a good job of keeping the dialogue regarding my health issues going while he types into the computer.  It is clear he is from a different generation than Doctor One.  But still, the appointment is interrupted 3 times by the need to bring in a redshirt to answer questions. 

“Is it going to be good” I ask, “you know, when you get it all mastered?”  He shakes his head negatively but doesn’t explain and we don’t have the time then to get into it, he has a whole day of patients already backing up and an even younger resident tagging along that day. 

When we finished the appointment he asks me to hold on.  He leaves and comes back with a copy of the notes he took during the appointment as well as a renewal Rx.  The printed document was nice, but it was printed, and on a system that will likely be seen only by other physicians at the university, not by others who treat me.  I will feel better when he makes his entries into my own personal EMR that is universally accesasable by anyone to whom I grant permission.  But for now, I leave the appointment as I always do with this person, feeling that he has given me the very best medical care he can give. 

Isn’t that the real point of it all?