What's wrong with the electronic medical record?

Host: We're broadcasting live at the AAMC in Baltimore 2015. This year's conversation is about change. What needs to change in health care? I know there's a ton of things, but we're asking each person what specific thing is on their mind right now.

Announcer: Asking questions, seeking solutions. Algorithms for Innovation, live from Baltimore at the AAMC 2015.

Yang: Hi. My name is Laurel Yang. I'm an emergency medicine resident at New York Presbyterian Hospital in New York City.

Host: Talking about change at the AAMC this year. There are a lot of changes that are going on in healthcare and that need to happen to make us better. What needs to change or what needed to change at your institution?

Yang: I think one thing that could be something that needs work is the electronic medical record system. It's something that takes up a lot of our time as physicians. I'd say probably half of my time is spent on the computer working on charts rather than seeing patients and giving them the care they need.

Host: Yeah. Does that internally frustrate you when you're looking at that computer screen?

Yang: It does, it does. It frustrates me, and more so it frustrates the patients and their family members.

Host: And you felt that.

Yang: I have. After you see a patient and you're trying to get orders into the computer and you're trying to get the note done so that you can move on and get to things that need to be done, the family members will come up and have questions, and want questions answered, and want things to move along more streamlined. Meanwhile, I'm still trying to get charting done and trying to get computer work done.

Host: Yeah. You have to get that done at that moment. It's like right now if I was to pull out my phone and bury my face in the phone, you wouldn't like that.

Yang: Right. No.

Host: Yeah.

Yang: Nobody likes it.

Host: What do you think? Do you have any thoughts for some solutions? Is there anything that you've done at New York Presbyterian?

Yang: First of all, I think it's a process of which electronic medical record are you using and how can we make it more efficient in that sense. Our IT department has been all over trying to make it more streamlined. Additionally, our emergency department has taken up using medical scribes to help primarily with the attendings and their documentation, although it also helps the residents in the entire streamline process of patient flow.

Host: The scribe will sit at the computer and type out while you're interacting with the patient. How's that been working?

Yang: It works pretty well. Yes, we have medical scribes who are on computers on wheels. They roll around the emergency department with the attendings. In general, it really helps for them. Sometimes they'll even document while we're presenting a patient to our attendings. The scribes will take down the HPI and take down the notes, and then we'll do a combined note that only the scribe writes that's approved by the attending obviously. It helps because we don't have to write documents then.

Host: How could that system be better? Are there some things that need to be worked out that you've witnessed?

Yang: Yeah. There are definitely hiccups in the system. I think one of the things that inhibited this from happening earlier and being implemented earlier was the fact that there's a medical legal component to it. These medical scribes go through an orientation process. They're for the most part pre-health students. They're not yet medically trained. Sometimes it's terminology. Sometimes it's a matter of them just putting together a coherent story in medical terms that we tend to use in medicine in general.

There's definitely a legal component to that, because if something is communicated incorrectly then that's in the document. After I think working out that, the attending approves it. There are little hiccups that we're working on, but in general I think it's a good thing and it's something that's helped ultimately give us more time with patients.

Host: Is that a good new created position for somebody that's interested in medicine do you think to actually be in the room and learn how to provide care?

Yang: Yeah. I think it's a great job for especially a pre-med or a pre-nursing student or if they're interested in going to PA school or in PA school. I actually was a scribe as a pre-health student. I graduated from college and worked as a medical scribe at a community hospital in Arizona. It was a great way to be exposed to clinical medicine and see the daily stressors of doctors and nurses and the stresses of that entire environment in the emergency room. You can imagine people are multitasking and there's always something going on.

It helps them put themselves in our shoes. Can I see myself doing that job? Sometimes it's not. Sometimes they realize, "Wow, really this is not for me" and they'll pursue a different profession or a different way.

Host: If I was at an institution that didn't have medical scribes, would you really highly recommend that I look into that?

Yang: I would.

Host: Yeah.

Yang: I would. I think it was a great way to get into medicine and it was something as a scribe that I could see myself working in. Ultimately I ended up going into emergency medicine, so obviously for me it had a very impactful way of realizing my ultimate profession and my career choice.

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