A View from the Trenches: Primary Care Physicians on Electronic Health Records

Abstract

It is one thing for pundits in ivory towers to describe the correct approach that practicing physicians should use in selecting and implementing an electronic health record system, for them to describe the essential reasons why it is to the physicians advantage to change over as rapidly as possible to a computer-based system of healthcare. It is another thing to actually make that change. Generals talk about the cloud of war, by which they mean that even the most carefully developed plans, conceived of in the quiet of the planning room, have to be carried out in a radically different manner than they planned when they face the confusion, disclarity, and realities of the field. This shift from theory to practice is also true of complex systems in medical practice. In the cloud of the office, the physician is often running four patients behind and trying to integrate a patients psychosocial needs with their medical needs while another patient down the hall is getting an EKG for chest pain. This is occurring simultaneously with trying to understand and integrate the new electronic health record (EHR). It isnt correct to say that knowledge and planning doesnt help; it does and that is why we have written this book. It remains important though to acknowledge that there are different sources available for learning - one is expert opinion and knowledge, the other is experience, the experience of individuals with whom you have something in common and who have decided to implement a system like that which you are considering and to hear their experiences, good and bad, with those systems. The goal of this chapter is to provide readers with candid, first-person accounts of primary care physicians experiences with a variety of EMR systems from a variety of settings. This should provide a balance of inspiration and consolation regarding a transitional experience that is changing the way medicine is practiced.