Charting: chore or charm?

This week, one of my colleagues cried over an artificial intelligence program…… because it helped her charting.It saved her a ton of time, like 90 minutes’ worth.It listened to her and organized an appropriate note, using her own diagnosis and plan, with no inappropriate paraphrasing.Since I’d previously written about the horror of electronic medical records (EMR) and even had the EMR play a role in one of my novels, I thought I should balance out my observations.To be clear, my colleague’s AI is separate from her EMR, so she has to copy and paste that information, but the program helps her make a better chart and save time.I don’t have anything so fancy, but the EMR of my current hospital is a step up. First of all, the dictation usually works. Yes, the microphone disconnects, and it definitely misinterprets any non-standard English name, but mostly, it knows what I’m saying. Sometimes it spells better than I do.Secondly, the medications aren’t always programmed to the wrong dose, e.g. defaulting to Tylenol 400 mg q 4 h and then if you accept it as the default, then it flags it as an error because it should be q 6 h, so you have to manually change it or override.Yes, there are medication irritations, but it’s not what seemed like 90% of orders on 90% of patients. More like 10% or 20% irritations, which I can handle.Thirdly, I can sometimes access past medical histories. I can almost always get Ontario labs now, and most radiology reports in the past few years, although for whatever reason, clinical reports are only maybe 30% to 60% available, and that’s a huge problem.Read: Dr. Melissa Yuan-Innes: What if they're killing medicare on purpose?Recently, I showed a family member that I could see the patient had visited a hospital in 2021, with the dates, but not actually read any emergency or consultant notes (blank spot where the actual report should be clickable). The family member pulled out a phone and brought the notes up for me. Kind of embarrassing, but whatever you need to do to get the job done, right?The little that I’ve poked into the history of EMR in Canada, it sounds like the provincial governments poured a ton of money into EMR that weren’t developed by or created with physicians and nurses, so we have lots of terrible EMR systems instead of one excellent national system. But maybe it’s getting better.And we’re all happy for my colleague who had a positive EMR experience. We’re losing physicians in general, but especially our all-precious family physicians, to the stinking morass of paperwork. Who wouldn’t want to save hours on charting?Who wouldn’t want an electronic scribe who could not only take notes, but help formulate a plan, nearly instantly?It takes you from being alone in your office, fighting through the rising tide of charts, to instantly completing that onerous chore.“I could immediately show it to the patient, who might say, ‘Could I have a copy of that?’” She wiped her eyes and smiled. “If I could save hours of charting, I could see more patients!”“And get paid better,” pointed out another colleague.So many times, I’ve had to sit through lectures of how EMR will help our productivity and make us more efficient, only to slow us down, set off tempers, and even provoke patient errors.I only hope we can actually get some good electronic help around here!Melissa Yuan-Innes is an emergency physician in Alexandria, Ontario and the author of Sugar and Vice.

Charting: chore or charm?

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Dr. Melissa Yuan-Innes

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