[semenko]

Physician scientist here: this study is a bit dated. Many of these issues have been "solved" (depending on your threat model) within the last ~7 years. Most healthcare systems have adopted Imprivata [1] for SSO, where physicians tap a badge and are connected to (usually) a VDI session of Epic.

What this study misses is the real driver of EMRs: billing. EMRs exist to facilitate billing documentation to charge for patient care. Yes, they have other benefits (like viewing lab results), but if you ever see true critical care (at the bedside, in an ER, or in an ICU) little depends on the EMR (or even labs for that matter).

A few comments here talk about patient notes: in most clinical environments, inpatient notes are useless, and a tedium required to bill. They're filled with copy-pasted jargon to meet insurance company requirements. True patient care happens in less than ~1 paragraph of text called a handoff. [2]

[1] https://www.imprivata.com/

[2] https://bmjopenquality.bmj.com/content/bmjqir/7/3/e000188/F2...

[wolverine876]

> A few comments here talk about patient notes: in most clinical environments, inpatient notes are useless, and a tedium required to bill. They're filled with copy-pasted jargon to meet insurance company requirements. True patient care happens in less than ~1 paragraph of text called a handoff.

That's very interesting, and explains many somewhat baffling experiences. So most of what I tell or give a doctor is effectively lost? That's the perspective from this patient, who finds it very frustrating to repeat myself, that the doctors are ill-informed and often perform that way.

But being open-minded: Is it that why I tell (or what most patients tell) the doctor isn't really useful to them? What is useful? Or is it just a consequence of time pressure?

[lazide]

Patients also don't usually know what is useful or not for a Doctor to diagnose them (or any medical provider usually). That has to be picked out as part of the Doctor or other medical provider questioning them and getting their vitals.

Some of it is implicit, like 'is the person able to form cogent sentences', or 'does the patient seem to be struggling to stand'. Others are more explicit, like heart rate, BP, 'what medicines are you taking', etc.

Often the ones who need the most help are the worst at getting anything useful out.

[wolverine876]

Sure, but I've told apparently critical info to doctor A, and then doctor B didn't know it (when I've told doctor B, it has changed their conclusions).

[nradov]

The patient's time has zero value to most physicians. It's often faster, and more clinically useful, for them to just ask you for your complaint and medical history. This allows them to guide the conversation and quickly focus in on the exact information they need. Searching through old chart notes is often a waste of time since the systems are slow and the data is frequently incomplete or irrelevant.

[calvano915]

> Searching through old chart notes is often a waste of time since the systems are slow and the data is frequently incomplete or irrelevant.

I believe this can change if we change the amount of patients a physician must assess and treat in a given time period. Because that would be super costly (way more physicians required on staff) Nurse Practitioners and PAs would be a more cost effective way to delve into important and relevant information that takes time to uncover.

[nradov]

NPs and PA time isn't exactly cheap either, and they aren't sitting around waiting for stuff to do. They can be effective at treating routine cases under supervision, however it just wouldn't make sense for physicians to delegate patients histories and chart review to them. They won't necessarily know which questions to ask, and too much relevant information can be lost.

[wolverine876]

> way more physicians required on staff

IIRC, as of several years ago, the supply of doctors is artificially constrained and hasn't really grown with the population.

[nradov]

Yes that's correct. Every year, students graduate from medical schools but are unable to enter clinical practice due to a shortage of residency slots. We need more government funding to remove that bottleneck.

https://savegme.org/

[wolverine876]

The healthcare industry has plenty of money to fund those things itself.

[retcon]

The UK has no link between doctors and hospitals, for a shining example. This reason alone is why so many expats I know return and receive better care from any old HMO just because the billing system glues together the case histories essential for infrequent attendants to primary care due to travel etc.

[abrichr]

Thank you for your first-hand account! For someone attempting to innovate in healthcare from the outside, this is very valuable information.

If you get the chance, what would you say is the biggest problem/limitation/shortcoming/annoyance associated with these handoffs?