Friday, April 15, 2016


    When the EMR , or electronic Medical records were introduced , it was thought that we will have better care. In fact the federal government paid physicians to participate in it . So many physicians got it. Those like myself who did not participate in it got reduced payments for the services than those who did get EMR . So now that we have it is the quality improved? In my estimate it has not only not improved , but has gotten worst. In the hospitals we HAVE to do EMR and I spend at least one and half hour extra doing it . On top of that I often see more things in the records than actually has been done .
    I get notes from other physicians . Many of them are 6 pages . When I go through them I find that 4 new lines , every thing else is same as was in previous last 5 notes . This is due to EMR. The notes are Generated by the computer and the physicians pit in minimal new information and rest is carried from old note which was generated on first visit. In one of the notes one physician who started labeling problems with alphabets rather than numerical numbers, at the end of the note he ran out of the alphabets and had to label AA,BB etc. Were there more than 26 problems that this physician addressed in 15 minutes visit? But the reason I am writing this today is due to one of the patients that I saw .
     I was consulted on this 48 years old patient for the diagnosis pf pneumonia . He had no fever , no t much cough , but the cheat X-ray showed some congestion. So he was started on antibiotics and I was asked to see him.He also had low blood count and so a blood doctor was also consulted. He had also history of heart disease and so a cardiologist was also asked to see him . I saw the patient . He had history of a disease called sarcoidosis and when I asked him as to how it was diagnosed , he told me that he had 'OPEN LUNG BIOPSY' . When I examined him . he had big belly. On examination he had enlarged liver and spleen and had fluid in belly. I had ordered CT scan of the chest and the Ultrasound of the belly. The CT scan showed that he did NOT have pneumonia and the mild congestion that was seen on plain chest x-ray was related to previous lung biopsy . The ultrasound of the abdomen DID show that he had cirrhosis of the liver and enlarged spleen and fluid .
    I did some further investigations. I called gastroenterologist and told the patient and his wife that he will need to see a liver specialist for consideration of liver transplant .
    I went back and looked at the EMR entries of one hospital doctor 3 different blood doctors and one cardiologist . EVERYONE had put belly examination as NORMAL on several different times . Some of these entries were done AFTER we had the US report showing enlarged liver and spleen . This the ' EMR and CUT and PASTE notes .   

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