Last Word

July 22, 2005

EHR? Count me out.

I live, breathe, and eat technology. I have five Palm PDAs, two notebook computers, five e-mail addresses, and a home network, but . . . I'm staying as far away from an electronic health record as I can get.

Now if I were just starting out in medicine, I suspect I'd jump at one with all the bells and whistles. But as a 59-year-old FP with a long-established practice, who's contemplating retiring at 65-or earlier, if the Publishers Clearing House check arrives-do I really need an EHR at this stage of my career?

For one thing, they're expensive. A good system can easily cost $30,000 to $50,000, plus yearly maintenance fees. I have only about six years to amortize the cost of the thing.

And then there're my pre-existing paper charts. I almost fell over laughing when a vendor assured me I could "scan all my records into the new system." Some of my patients' charts go back 30 years and are six inches thick. If I hired a new employee to do nothing but scan charts, let's see, at six pages a minute, my 10,000 charts might get done in a year. Clearly, unless you're starting from scratch, paper charts will be with you for a long time.

And what do I do about all the new hard copy stuff that arrives each day-the MRI reports, letters from consultants, living wills, and whatnot? When you scan the stack, the information doesn't just automatically leap to the correct place in the patient's electronic chart. I'd need a second new staffer, trained in medical terminology and document management, just to get the data where it belongs.

And what happens if a patient leaves my practice and requests that I send her records to her next physician? Can my EHR talk with his? Not in the foreseeable future. There's only the slightest chance I'll be able to export her electronic records in a format his system can understand.

No, as things stand now, the EHR is not for me. Aside from the scanning and interface problems, I'm not sure it can handle the other, even more important, realities of my everyday practice.

For instance, how does it fit into those old-fashioned doctor-patient interactions, the neighborly, face-to-face kind that make up the best part of practicing medicine?

Can it replace those all-important notes you jot in the margins of your paper charts: "Tomatoes, new grandchild, six-pound bass"? Reminders to ask on the next visit, "New grandchild must be seven months old now?" or "Caught any more of those lunker bass?" or the most important, "Got your garden in yet? You always have the best tomatoes."

Talk tomatoes with an obese, noncompliant diabetic, and he's going to come back to follow up. And he'll probably return with an enormous bag of fine, ripe tomatoes come August, and maybe even some corn, zucchini, and raspberries.

Show me an EHR that will prompt my failing memory about personal things like that, and I might sign up.