Outlook and EMRs: Culture Clash in the Medical Office

I have many equally important administrative and clinical duties, but I miss many more meetings than patient appointments. The reason for this is simple: Non-clinical activities are scheduled by non-clinical people in Microsoft Outlook and patient appointments are scheduled in our EMR.

No-showing for a patient appointment is extremely bad patient care, and I go where the EMR tells me to go.

Outlook can send instantaneous, simultaneous invites to hoards of people, who with one screen tap or click can accept and populate their schedules years in advance.

The EMR requires specially trained and authorized people to custom create blocks of various types which may show up in one (grid) view but not in another (list) view.

This is a small, but telling example of how an activity that even the most basically computer literate person handles automatically in the business world requires special skill and privileges in a modern EMR.

Non-clinical coworkers are still puzzled by my seemingly erratic meeting attendance, and they give me blank stares when I suggest they stop using Outlook and make the EMR their appointment book and message hub. They’re no fools; they know how clunky my technology is.

And (I’m on a roll now), compare EMR messages with email: If a clinical message in my EMR has various new timestamps and comments added to it, it doesn’t move to the top the way emails do; it stays in the order it was created, so while I never miss a patient appointment, I do miss new information in patient communications.

Why does my EMR not work like modern office computer programs? It’s a rhetorical question we all know the answer to: Proprietary functionalities of their software with lack of interoperability is a cornerstone of the business strategy of EMR vendors; profits to be made as long as customers stay with the product. And the more expensive and complex it would be to migrate data and retrain people, the surer those ongoing profits are.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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