Opinion | OMG! Did the EHR Folks Actually Get Something Right?

Lo and behold, believe it or not, I think they’ve gotten something right.

Just recently I started getting work emails informing me that I have orders to sign on a patient, and requesting that I click on the link below. The only identifying information was a patient’s first name and last initial. Then, temptingly, below this, was one of those “Click here” buttons.

At first I thought this was another phishing email, even though it was listed as coming from a company that has an association with our electronic health record (EHR) for filling durable medical equipment orders electronically. In fact, the first time I got one of these emails, I reported it to our IT service as potential phishing, but then they replied that it was clear and valid. Click away!

The body of the email came with the first name and last initial of a patient that I recognized, and clicking on it I saw a set of electronic orders for some durable medical equipment that made sense based on their medical conditions.

Now, I had not placed these orders, and for this particular patient they’d recently been admitted to an outside hospital, followed by a stay in a rehabilitation facility to help them along in their recovery, but the items listed on the orders seemed appropriate for what I’d heard had happened to them during the hospitalization. So I clicked on the button and was instantly rewarded with the little emoji that celebrates that you’ve done something right — I think it was the party hat with some confetti — it was supposed to make you feel really good about what you’ve done.

All in all, this is much better than receiving a fax, having to hand-sign page after page of orders, and then having somebody from our office fax it back to the company — followed by a fax from them telling us we had done it wrong, do it again. Or followed in rapid-fire succession with multiple other faxes saying second request, third request, fourth request, “urgent — please reply immediately.” If in fact we can figure out a way to make all of these extraneous things happen seamlessly within the electronic medical record, we will undoubtedly make a lot of people a lot happier.

Since this patient hadn’t been admitted to our hospital but to another hospital elsewhere in the city, we didn’t have their medical records yet, but I had been in communication with their family about what had been going on, and it was reasonable for me to be signing orders to continue their care.

Contrast that situation with this one: recently a patient of mine was admitted to our own hospital onto a sub-specialty surgical service for a prolonged complicated course. On the day of discharge I was faxed a dozen pages of orders to sign, all related to the condition that someone else had been caring for, and asking me to give home care orders and medications and other treatments that were way beyond my comfort zone. If this had just been built into our own EHR, those who knew the case and the care plan best would have been more than happy to guide the patient’s safe home care moving forward, instead of leaving it up to the primary care physician to sign papers, like that is our role in life.

Wouldn’t it be great if we could imagine a world where all of this stuff happens seamlessly, where all the home health aide forms, medication orders, durable medical equipment orders, nursing orders, and wound care orders could all be cleanly and seamlessly built into the EHR, a shared place where we all look at what’s happening, agree on a plan, and bless it, moving things forward with the click of a button?

Hopefully, as we prove that this works for certain things, the powers-that-be that run these systems will start to incorporate more and more things into the electronic health record, so we don’t have to hunt in multiple places, be it our email, our fax machine, or regular old snail mail, for the things that our patients need to safely get continuing care. And we long for the day when every hospital system and every private doctor’s office will be on the same system, or at least be able to speak to each other in a shared language, where we can all see each other’s notes, where we can all see what’s going on, where we can all communicate in ways we understand to safely take care of our patients.

Cut out all of the administrative stuff, all of the other clicking and box-checking and other things that clutter up the medical record, and make it for once a place where we rule the roost, where we put down what we think needs to be there and not what someone else wants us to say.

E-prescribing of medications has been revolutionary, life-changing, a huge boon to the lives of doctors, and now with the addition of easy signing of orders for certain types of durable medical equipment, we are continuing to move the dial forward in a positive way. Hopefully someday soon, we’ll all be on a shared system so that notes from every other interaction with the healthcare system are always there for everybody to see, without a lot of additional paperwork, frustration, and time needlessly wasted.

If electronic health records are going to fulfill the dream they have promised, then it has to be the dream that we’ve had, the dream that satisfies the needs of the doctors and the rest of the healthcare team, while safely allowing the patient to get the best care they can — the right care at the right time.