I was in the military in 1992 and stationed at Tripler Army Medical Center. I believe the Army was one of the first ‘institutions to use computers for much of the hospital work that we did. I have therefore ,been involved in Electronic Records and the use of computers for clinical medicine for many years. The most complex of these programs, called Epic, was properly named given the horrendous effort it took me to understand and use this program. This method of patient documentation, data retrieval and medication/lab ordering, has been suggested as a method to eliminate the possible mistakes that can occur from doctor’s messy handwriting and a more efficient way to retrieve patient data and documentation. Therefore, this method of patient care will benefit the medical staff as well as the patients.

I have come to realize that although there are some benefits to using these programs, the primary motivation for their implementation is to allow the Insurance companies to dictate how we formulate a progress note, what the note will include and the proper coding of the visit. This lengthy and cumbersome documentation is quite convenient for the Insurance companies but requires the physician to be a skilled typist, coding specialist and includes items in the note not important to the visit. The physician is often staring at the computer screen, frantically entering all the “necessary” information while hopefully listening to the patients problems.

We need to see more patients given the low reimbursement rates from the insurance companies but we are shackled with creating this massive progress note. I can see a patient for a sinus infection in about 7 minutes but to complete the computerized note and the coding takes another 15 minutes. Furthermore, those of us who work for a large company, most of us, have found that this supervising organization can follow our every move. They can track the improvement in our diabetic patient’s A1C with a click of a button. I was called by the Administrative staff once and asked why I had not returned a patient’s phone call after a few days. We can be watched and tracked in every way possible.

I believe that the primary motivation for the implementation of these electronics is for Power and Control by the Employers of the medical staff and for the ease of the Insurance companies’ billing and reimbursement needs. The doctor’s progress note used to be for the rapid documentation of the patient’s visit so that the physician or other providers, could review what happened during that visit. The older physicians speak of the time when they saw 25-30 patients in a day with ease. This task is either not currently possible or requires a 5 minute visit while the doctor spends hours at the end of the day typing away.

I wish we could go back to the day when patient care came first and the documentation of the visit, a distant second. These older physicians could end their day satisfied that they provided good, comprehensive care and that the patients were addressed in a very personal way. This dream will likely never occur again and we can only long for the “good old days”.