Bob Wachter

I can tell you that no doctor was happy about being transformed into a data entry clerk.

And patients noticed it.

They went to see their doctors, and their doctor had the head down, typing away.

And why did that happen?

Because the computer became this enabler of all of these outside entities who used to have no ability to influence what the doctor did because I was scribbling on a piece of paper, now had a way of making me check 12 boxes about did I examine nine body parts and did I ask you if you wear seatbelts?

Do you exercise and all that?

All noble questions, but now there was a forcing function that you could make the doctor record all this stuff, and so people did.

And importantly, when we send a bill off to the insurance company, the amount of money we get paid is partly related to the nuances of how I record the note.

Which creates some perverse incentives right there.

Totally, totally ridiculous incentives to say the right words in order to get the best bill.

And then a few years after that, federal legislation mandated that patients could not only see their basic information and maybe their medications, but actually could read my note and see their x-ray results and see their lab results.

There was absolutely no information to help the patient figure out what any of that meant or even to make an appointment.

Other than to maybe forward the results back to the doctor and say, I'd like an explanation, please, which just sludges up your inbox even more.

The companies did what seemed logical.

They put a little button at the bottom of the screen that said, send a message to your doctor.

Lo and behold, patients being normal human beings click that button all the time.

Electronic health records have led to a huge increase in what is called pajama time for physicians.

We talked about that in an episode called The Doctor Won't See You Now, number 650.

The American Medical Association, in a recent survey, found that roughly 20 percent of physicians spend eight or more hours a week outside the office wrestling with electronic health records.

But it seems that a new day may finally be dawning.