An article from the Tulsa World today featured pictures of nurses at a local hospital staring at their new computers, as their hospital has recently implemented an electronic medical records system (EMR).  Who’s not pictured?  The patients, abandoned by these computer-surfing nurses.  Been to a hospital recently that has an EMR system?  When the nurse came to the room with their computer station on wheels in tow, did they type as they asked questions?  Did they have their back turned to the patient?  Was the computer station on wheels actually positioned between the nurse and the patient?  Were they checking boxes or were they actually typing narrative?  Hint:  they were using the mouse more than the keys.  Did they ever say in response to a patient’s answer, “that answer is not one of my choices here…let’s try again.”  

Ever come home from work to find your kids’ faces buried in their phone/computer/television?  Have you found that in order to communicate with them effectively these distractions must be first set aside?  It is no different in health care.  While EMR is a distraction as part of the hospital ward, it is extremely dangerous in the operating room.  Nurses type wildly to finish their operating room records with their back turned to the surgical field the entire case.  It is similar to a situation where both airline pilots are playing Super Mario Brothers during a flight.  They would simply have no idea of what was going on.  

The notion that these EMR systems are going to improve safety and enhance patient care is ludicrous.  All the “right” boxes will be checked, though.  I wonder how long it will take for a nurse to type in all the “correct” prompted responses and check all the “correct” boxes at a patient’s bedside, all the while not realizing that the patient has already died?  This happened when I was in training years ago.  A nurse at a VA hospital called at 2 am to tell me that a patient needed a new IV, because their IV pump was alarming.  I arrived to find a stiff and cold patient.  The vital signs for this patient for the next 8 hours had already been charted as normal.  This patient was probably dead before this nurse’s shift had even started.  She never laid eyes on them.  These EMR systems represent an intense distraction, one that will, in my opinion, separate nurses from their patients like nothing else ever has, and will increase the likelihood of horror stories like the one above.

Our federal government is punishing those who don’t adopt EMR systems by lowering their Medicare payments.  The government is also paying a significant percentage of this EMR expense.  How could Uncle Sam’s endorsement be wrong?  Why couldn’t EMR market itself without Uncle Sam’s cannons and tanks?  Every other intervention of the federal government in medicine has worked out great, hasn’t it?  Do you think the hospitals will ask patients for their consent before sending all of this patient data to “the government?”  

We have no plans to implement EMR at The Surgery Center of Oklahoma.  Ever.  Our nurses will look right at you without the distraction of this EMR insanity.  Our operating room nurses have no mouse or typing to distract them from the needs of the patient or the surgeon.  Our recovery room nurses lack this deadly computer distraction, as well.  One of my recovery room nurses actually came to work for us from a local hospital because of the danger she thought EMR represented in the recovery room there.  If you’ve been to a hospital with EMR recently, you’ll notice the difference immediately if you come to our facility.  There is simply no substitute for interacting with people that are not hiding behind their machines.

G. Keith Smith, M.D.