Shirah Vollmer MD

The Musings of Dr. Vollmer

What Happens to EMR When the Internet Goes Down?

Posted by Dr. Vollmer on April 25, 2016

Electronic medical records  are here, and for many reasons, they offer tremendous improvement in patient care. Laboratory values are organized. Medication lists are kept current. Immunization records are tracked easily. On the other hand, the typing into the computer by the physician impairs the doctor/patient relationship, a subject that deeply hurts me as a professional. Yet there are other very dark sides to this transformation in medical care. One is the loss of privacy, but the other is the strong dependence on internet service. When the internet goes down, no care can be provided because there is no medical record to access and without a medical record, prescriptions are not right and terrible mistakes may happen. Sure, in the old days, charts could not always be located, and this was indeed a huge issue, but that might be one patient in a week, whereas now, if the internet is down, every patient is impacted. Suddenly continuity of care transforms into an urgent care, where immediate issues are attended to, without the benefit of a history. In the mental health world, which is so dependent on a history, little can be done without a medical record, and hence without internet.

Today was a case in point. I work in an addiction rehabilitation facility which uses EMR (electronic medical records). To my surprise, when I started, I found the system efficient and useful. From any computer I could access patient information and attend to issues quickly and smoothly. My notes serve to jar my memory so that I could stay current with patient concerns. I could type while maintaining eye contact with the patient so I did not feel it impaired my developing relationships. I was pleasantly surprised by my enthusiasm for this new tool until today. The internet connection was poor, not non-existent, but poor. My fast pace at this job slowed to a crawl. I found myself in pain, waiting for the record to “load”. Each entry lead to more pain, as it had to “load” again. The efficiency instantly transformed to inefficiency. With written notes I could move more quickly; at least today, that is true. There was no dire consequences. All of the patients were seen, understood briefly, and given appropriate prescriptions, but my frustration level was high and so it goes. As we change technology, we change our stressors. This post, as you can imagine, is my release valve.

2 Responses to “What Happens to EMR When the Internet Goes Down?”

  1. Shelly said

    What about patient rights to privacy? What if patients say something in confidence to you and don’t want everyone in the facility to read it? With EMRs, everyone in the entire HMO has access to privileged information. I personally have had experience, where I live, that everything in my medical record is open to every specialist, nurse, and secretary who opens my file to read. I finally told the clerk at the front desk to stop calling me to remind me to get a breast exam that I had access to mammograms where I work and to stop bothering me. It is nobody’s business but my doctor’s and mine and I resent that every time I go and visit a specialist of one sort, they have access to all my medical records from every doctor I’ve ever visited.

    • Yes, the lack of privacy is a huge downside to EMR. There is no question that your story is common and even worse, the records can be hacked and fall into other hands outside of medical professionals. Everything is a trade-off and so the question is whether EHR is worth it. I am not sure. Thanks, as always.

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