A few years ago I was sitting in a meeting discussing electronic health records. Another in a series of “upgrades” was occurring and there were some expected “un-expected” consequences of the upgrade. Several common pathways to placing orders and reviewing results had been changed. “The information is still there…” I was being told. “You just have to access it this way, now”. It seemed completely benign to the well intended IT person sitting across the table form me. Yet this new process required several more clicks to achieve the same result; 5 more clicks to be precise.
I explained to my IT colleague the additional number of clicks required and received an unexpected reaction … “5 more clicks? You count mouse clicks?”… Yes, we count clicks. It’s my new reality. I count mouse clicks to renter orders and retrieve results, I count telephone digit entries required to access dictation recordings, I count login entries required to access patient records, and I count clicks and key strokes required to view diagnostic images. I count them because it matters to my patient.
In my typical 10 hour shift, I have 600 minutes. If I spend 30% of my time interacting with a computer and the assumption is that my patients are getting the other 70%. But that isn’t the case. I interact with nurses and ancillary staff, I hunt for clerks, and I spend time talking to consultants. All of that takes time away from my patients. What started as 600 minutes is now only 420 minutes of human interaction. Splitting that amongst all my duties, I have less than 300 minutes left to devote to my patients. When faced with that reality, 5 mouse clicks that I have to perform 100 times a shift adds up quickly.
We all know that electronic medical records have increased the amount of time that physicians spend in front of a computer, and decreased the amount of time we spend with patients. Yet we continue to allow increasingly burdensome systems to enter our work areas at an alarming rate. The responsibility doesnt just rest with the creators of the systems. They respond to market demands. The biggest burden rests on the shoulders of those of us who make decisions on behalf of our colleagues, wether they be physicians, nurses, or other staff. We need to be asking: how does this make things better for our staff and patients? AND, how is this workflow different than the system we already have? And if we don’t get satisfactory answers, the only responsible course of action is to wait for a better system. If we do not advocate for the time we hold most precious, time with our patients, who will?