If you’re like me, you’ll probably be a bit surprised (pleasantly) by the following video, which can be found embedded in an equally interesting blog post on EMR feature-creep or “featuritis” by Dr. Charles Webster. (I would have shared the video here but it’s only available on Dr. Webster’s site.)
In it, the ever-insightful Dr. Webster details how a peds practice has gotten to the point where a routine encounter takes 37 seconds to chart using the practice’s pediatrics-specialized EMR, as follows:
| 1:08 | I open the chart |
| 1:13 | Chart my physical exam, my pharyngitis exam |
| 1:19 | Chose my diagnosis of strep pharyngitis |
| 1:25 | Make my treatment duracef and follow up in 3 days |
| 1:31 | Write my prescription |
| 1:33 | Edit my follow up if necessary |
| 1:37 | Have created a beautiful chart |
| 1:42 | Check my billing |
| 1:44 | And I’m finished |
That may sound extreme, but it’s not, he says. “I’ve looked at timed studies of our current physicians’ charting at pediatrics or family practice, and the average chart for a sick visit is 28 seconds,” he notes.
As if that wasn’t sensational enough for an audience expecting EMRs to make everything tougher, he had more to share.
“In reality, with a finger or a stylus you can do this in about a third the time,” Dr. Webster told them. In this case, that would mean 17 clicks in 12 seconds, but people can generally tap their finger at that pace with little trouble, he says. Not such a big deal.
That being said, it seems likely that going forward, doctors will need to better develop the cognitive motor skills of musicians — the ability to step up eye-hand coordination to be sure — if they want the best results out of their systems. Dr. Webster says he’s planning a future post which critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill. I think I’ll want to catch that one!
To take this to an extreme, there are charting systems that start you off with a complete note which you “edit to accuracy.” So if the patient happens to present exactly like your chart, then it’s one click and you’re done. It’s efficient, but it’s bad medicine.
But it’s not one click. It’s 17 clicks. For a routine ear ache. Even that’s ridiculous. What should be the minimum number of clicks to qualify as good medicine? Talk about cookie-cutter mentality.
The problem isn’t clicks per se, it’s any task that requires thinking about the software instead of the patient—or put another way, any task that displaces a doctor’s working memory. Clicks that produce predictable results that support your thinking are better than clicks that don’t, whether there are 2 or 35.
But my point was if you’re using lots of templates to reduce clicks then you’re trading accuracy for efficiency. The narrative is still the best way to understand the human being in front of you, and it’s usually clickless.