Electronic Medical Records

30 Million Mouse Clicks And Then You Die

Someone once said that every person is born with a fixed number of heart beats and that our lives count down with each beat like grains of sand in an hourglass. I think the same thing happens with mouse clicks. If you do the math, it works out to about 3 billion heart beats during the average person’s life in the United States. In a previous post, I noted that the typical emergency department physician does about 4,000 mouse clicks per shift. That works out to about 25 million mouse click over the course of an ER doctor’s career. Add in another 5 million or so during medical school and residency and you get to 30 million.

So, if we can reduce our mouse clicks, can we live longer or have longer careers in medicine?

I figure that each mouse click takes about the same amount of time it takes me to speak a word. 30 million words would fit on 54,000 pages and fill 134 average length books. That is a lot of spoken words. Many physicians (and their patients) lament the amount of time that the physician spends staring into a computer monitor and clicking with a mouse during patient office visits. So, if our careers tick down one mouse click at a time, is there anything we can do to prolong them and reduce those mouse clicks that steal away the words we could be speaking with our patients? Electronic medical records are not going away, at least not any time soon. But there are some tangible things we can do to decrease our mouse clicks.

EMR designers need to engineer efficiency into the physician interface. When it comes to mouse clicks, less is more. The fewer mouse clicks it takes to navigate through a patient’s encounter, the better. This will often require the EMR to be able to be custom-configured by individual physicians so that the navigation through an encounter can take on the unique needs of that individual physician.

Staff must work at the top of their license. Whenever state and federal regulations permit, the medical assistant, LPN, and RN should be able to do as much in the EMR as they are allowed to do. Every mouse click that the MA can do is one less mouse click that the physician has to do and that equates to one more word that the physician can speak to or hear from the patient.

Physician should periodically re-train with their EMR. Most electronic medical records release periodic updates that improve on past versions. Optimization allows the physician to take advantage of these periodic updates in order to become more efficient with their EMR. But most physicians still use their EMR the way that they first learned how to use it when they went through their first EMR orientation. The strategic use of smartlists, smartphrases, and webpage customization can greatly diminish the number of mouse clicks it takes to complete a patient encounter.

Regulatory agencies need to eliminate unnecessary documentation burdens. In the interest of attempting to ensure high quality care, Medicare and insurance companies require physicians do document all kinds of things in the medical record. For every patient visit, we have to click to acknowledge that we have reviewed that patient’s problem list, allergies, medication list, and smoking history. The cold reality is that most physicians click through those items without really doing them – they are prompted to review these things before the encounter can be closed and the bill submitted – often after the patient has already left the office. The path of least resistance in this case is usually to go to the problem list page, scroll to the bottom of it, and then click on the button that says you have reviewed the problem list – most physician just click the button and never review or edit the actual problem list, which is often 30 or 40 entries long. And then there is all of the mouse click associated with billing – a click to link a specific diagnosis with each individual billing code, a click to add a -25 modifier whenever a procedure is done on the same day as an office visit, a click to add a -GC modifier if there was a resident or a fellow with you when you performed that office visit. These things add very little value to the actual care of the patient but steal away words that can be spoken with the patient.

Maybe reducing mouse click won’t really make us live longer or extend our practice careers. But reducing mouse clicks will free up a few extra minutes each day that we could be listening to our patients and talking to our patients.

November 4, 2018

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital