UPFRONT

Time to “Think Different” About EMR

Peter K. Kaiser, MD

“That's been one of my mantras — focus and simplicity. Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it's worth it in the end because once you get there, you can move mountains.”
— Steve Jobs (BusinessWeek Interview, May 1998)

As many of you know, I am a true Apple fanboy. I have been one since my first Apple II in high school. I am not a recent convert, like the masses following Apple's resounding recent successes, such as the MacBook Air, iPhone and iPad. I prophesized on the elegance and simplicity of the Macintosh operating system well before Windows copied it and even sunk my only available cash to buy Apple stock when it was $10, foolishly thinking it would help the company (little did I know it would help me!).

When the first Macintosh computer came out in 1984, producing a word processing document changed forever. Prior to the Mac, we would use our keyboard arrows to move around the screen to edit. There were mouse-pointing devices available, but no prior computer made the whole operating system revolve around it. Windows, menus and drag-and-drop were all new ideas, and they changed how I wrote my college papers. The computer worked with me to make writing easier.

Nowadays, I reach into my pocket and marvel at the beautiful user interface of my iPhone, and curse every time Siri tells me she does not understand me (a rare beta release from Apple). It is second nature to scroll or zoom in on maps or Web sites. I move around the screen without thinking about it. But then I walk into my clinic and look at the computer screen sitting in my exam room and I am quickly brought back to 1983.

At the Cole Eye Institute, we are slowly moving all our doctors to electronic medical records. We are the last department in the Cleveland Clinic to move to EMR, partly because our specialty is so visual and the system the clinic uses is not. When I look at the almost DOS-like screens of our chosen EMR provider, I cannot help but think, “What would Steve have done?” Having just read his biography, I know. He would have fired all the programmers and started from scratch to produce a program that worked with us and not against us. He would probably make it work in ways we could not even imagine.

Cole's transition to EMR has been very cautious, with long hours spent with programmers to make the system more “Mac”-like. Dr. Rishi Singh has taken a dog and made it into a… better looking dog, because he could not change the under lying code that was years old and unforgiving. He was able to make the user interface better, which makes our life better in clinic. However, I wonder what a practice without our resources would have done. I am sure they would have had to change their practice patterns to adjust to their chosen EMR.

Speaking to colleagues, I know this to be true. One friend of mine saw his productivity drop 30% before adding a scribe just to get through the day. In this issue, we discuss the trials and tribulations of bringing EMR into a private practice setting. I know many of you think the same thing when you answer a call on your iPhone: What if Apple had designed our EMR?