My teeth and my dog have EMRs, but the rest of me's on paper

Sometimes you don't notice how ludicrous a situation is until you see it first hand.

A few weeks ago, I scheduled a routine visit with my new primary care provider. He's a young doc, part of the physician practice arm of my large IDN employer, a name you'd recognize instantly as one of the best in the industry. That made him my colleague, so since my appointment was his last of the day, we chatted a bit.

He asked about the hospital's CPOE and EMR projects and I asked about those of the clinic in return, figuring that we were Hot Stuff and therefore probably state-of-the-art on the ambulatory side. He said they were supposed to get a new EMR system, but that higher-ups were making the decision and he wasn't confident they would take the practicing physician's needs into account. Until then, the practice was all paper- and film-based. The only information system in-house handles scheduling and billing and is used only by the clerks. I got the sense that he felt powerless against the unseen enemy, the IT-types and non-practicing docs who were making automation decisions on his behalf but without his input.

I threw out an obligatory comment that maybe CPOE wasn't all it was cracked up to be. He said he welcomed the day when he and his peers could use automation for recordkeeping, reminders, and research. He was wistful for the practice he came from, which had a paperless system that helped him rather than making his job harder. He readily admitted that it took longer to enter data, but less time to retrieve it.

I filled out a lot of forms while at the office, but I have no doubt the information won't find its way to our ED or inpatient facility if I visit there. It's tucked away in a manila folder somewhere in the clinic building. I must have written my date of birth and allergies on at least three forms, but I'm not expecting that any other part of our large enterprise will have access to that information.

A few days later, I visited a new dentist for the first time. He took the usual x-rays and then had me wait back in the chair. Minutes later, he swung over an attached LCD monitor and went over every image with me. He wanted one retaken since the image wasn't clear. His one-man practice was pure PACS -- no film. Everything from the exam was on the screen and he went over it in considerable detail, magnifying and highlighting and comparing. He wanted me to visit a periodontist, so before I even got back to the checkout desk, he'd e-mailed the images over.

I asked him about PACS and he was thrilled with it. Better images, available anywhere, and displayable even when he was doing procedures. He even had a little pen-sized USB camera and showed me live video of the inside of my mouth while he was poking around in there. All of this appeared to run on a standard Wintel PC, including the video feed that let me choose a Three Stooges video to watch on the LCD monitor while the hygienist cleaned my teeth.

Yesterday we took the family dog to a new vet for his vaccines. We chose a vet-in-a-box within a large pet store, figuring Bordatella is the same no matter where you get it. The "pet nurse" recorded some information, then asked if we had prior records. We'd brought paper copies from our old vet, poorly reproduced versions of bad handwriting. She muddled through trying to find specific information, joking that she hated dealing with paper records. Some of the handwriting was unclear, so she had to ask the vet for help deciphering some of the information and verifying that Canine Mr. HIStalk had had his rabies vaccine under a different brand name than the one they used.

We went back to the treatment room and she showed us a mounted tablet PC right by the exam table. She explained that everything would be completed online and that the system had videos we could see right on the screen if we were interested. She pointed out what she was doing: recording temperature, heart rate, etc. electronically on a simple, easy-to-follow screen, using a stylus. As she entered each data element, various parts of the screen opened up for more information or turned red or green to show missing or abnormal information. Once she had entered everything she was prompted for, she prepared the vaccine and the vet came in to review the screens and administer the dose.

The system recommended particular items, such as food or further treatments (an upsell technique, but one we appreciated.) We said OK to a plaque-fighting treats, which were immediately added to our bill and brought to us. We said maybe to a prescription dog food, so we got a printed prescription card immediately with all information needed to purchase it now or later. Back at front desk, an itemized bill was waiting, along with several information sheets printed specific to our dog, the prescription records, and a printed version of the vaccine records we'd brought in on bad photocopies. Cost for the visit: $29.95 plus $16 for the vaccine. For that, we got a pretty good exam, some recommendations from the vet, and the knowledge that all of his information is on file if they need it.

Having dental PACS images was convenient, since the periodontist got the information even before I'd left the DDS's office. Having the dog's information safely entered to make it easier for our next visit was comforting, since we knew it would be quick and available even if the vet was paged at home for some reason. No one in either office griped about the cost, complained that it was more work for them, or lamented that paper was better.

The irony was acute, particularly for someone in the healthcare IT business. The dentist and the vet were fully on board with electronic records. They were proud of how much better their practice was than when they were paper-based. In both cases, they used the system along with the patient or had information entered by support personnel -- they didn't scrunch over secretively in the corner and ignore you while doing it, nor did it add any perceptible time of their own to the visit. They used the system as a teaching tool to emphasize what they were saying. They also let it do what computers do best -- to remind them of things to do, to print standard information, and to guide them through the standard encounter.

I'm happy for my teeth and my dog, but somehow the rest of me feels shortchanged.