A moderate number of years ago, a new innovation came to my field: radiofrequency energy delivery to burn (ablate) tiny areas of the heart. The lesions created with this form of energy were more uniform and controllable compared to the direct current energy we had used before. As a result, doctors quickly migrated to this form of energy to perform their heart procedures. In turn, manufacturers of the machines to deliver radiofrequency energy rushed to develop sophisticated devices that measured power, impedance, and the temperature achieved at the catheter tip within the heart. All of these measurements were used to assure safety of the procedure and with these machines came buttons, knobs, dials, digital displays, and analog displays galore.
It was an engineer's playground, but a technician's nightmare.
But as the years went by, I noticed something interesting. The device that ultimately gained the largest market share was the one with the fewest buttons. It was easy.
And also, safe.
Lately, I have notice a disturbing trend in the development of our electronic medical records: there's no more room for buttons (or menus) on our computer screens. Increasingly, I find I have to scroll up and down or find buttons in drop-down menus as I care for patients. Buttons and more buttons, many of which I don't use.
* Click Click Click *
* Scroll *
* Click Click * "Damn, where is it?"
Before people think this post will devolve into a screed against the electronic medical record (EMR), relax. I am not a non-believer.
But I am a realist.
One only has to look at the complexity of today's TV remote controls to understand the problem.
Electronic medical records are rapidly being developed to replicate exactly what we are currently doing to medicine to make sure the entire team of health care providers (doctors, nurses, technicians, secretaries, scheduling personnel, supply officers - EVERYBODY) do things in it a certain, pre-defined (and regimented) way as we care for patients. As they get more intricate, we see the integration, and the associated complexity, and are awed.
But as I step back and look at these systems from 50,000 feet, the engineer-doctor in me becomes concerned. That's because of several very human realities that we must accept:
- First is the shear number and volume of information we are asking our staff to enter for procedures. Electronic medical records are morphing from the classic written chart to supply systems, safety systems, billing systems and care systems incorporating every governmenal regulation known. Patient here? Entered. Timeout? Entered. By whom? Entered. Surgical sight? Entered. Groin prep? Entered. Type of prep agent? Entered. Duration of prep? Entered.
Buttons. Buttons. Buttons.
As more and more eyes are glued on the computer screen, fewer and fewer eyes are directed toward our patients.
- Second and perhaps more concerning, buttons are static. Because they are hard-wired, buttons replicate the status quo and deter innovation. What happens, for instance, when a new button is needed because of a new development in medicine? Will systems be able to be easily adapted by end-users or will a programming change (and the ripple effects to other programs) be required, debugged, and tested before they can be safely implemented? What about the risks to safety as more and more hospitals want to implement other button changes system-wide? Will programmers be reluctant to make changes because of the impact (and re-training costs) required? What if a simpler way is found to deliver care that removes the need and cost of all these tedious checks and balances, will we be able to change?
- Third, there will never be enough buttons to account for every variable seen in medicine. Free text will still be needed in data fields. Button-ology has limits.
- Finally, buttons are getting expensive. There are so many buttons now that scribes are increasingly being employed for data entry as doctors struggle to free themselves from their burden. For every person hired for data entry, the reliance upon (and cost of) our button-filled systems mounts. Might these additional personnel soon be requirements for successful EMR implemenation?
Otherwise doctors and administrators might find the most cost-efficient way to perform data entry might evolve back to pen and paper.