An unexpected benefit of implementing EMR

This blog has been mostly a place for me to record my life with boys, but here’s a completely different subject, just for a change:

On January 3 of this year, the clinic I work in went “live” with an EMR – electronic medical record system. Our entire university medical campus is slowly implementing the EMR, department by department, division by division. It’s been ongoing over the past two years, and has had its bumps along the way. Ultimately, we are mandated to go electronic by October of this year.

I had already used the system that is being implemented in another clinic a few years ago, and I was very happy to see it coming to our clinic. I knew many of the advantages, as far as time saving shortcuts in documentation, the ease of e-prescribing, and the ability to graph lab results to view trends over time, and track weight and blood pressure. But last week, I discovered an advantage that I never would have predicted.

The last patient on my schedule was a gentleman that I’ve seen every 3-4 months for the past 6 years. He had previously been the patient of another provider who had left, and when I met him, he had no active medical issues, other than the underlying HIV infection, which was well-controlled. With the time constraints of the usual clinic visit, and the fact that our paper charts often don’t show up with the patient, I had never really had a chance to learn the background of this patient’s life which I normally learn when I do an initial history & physical exam on a first visit with a patient.

With the new EMR, it’s really easy, with just a few keystrokes, to fill in past medical history’, family history, and social history questions (these usually include occupation, education, and those lifestyle issues that impact health, such as use of tobacco, alcohol, drugs, and sexual behaviors – the last is usually a particularly important issue in my particular specialty). So, I started tabbing through these areas of the EMR, filling in data, and, in the process, I came to know this man better in 15-20 minutes than I have over 6 years. He told me of his family – he’s the oldest of eight kids. He told me of his parents. He told me about his time in the service – he spent time in Vietnam. He told me about the girl he dated in high school, and how she ended up marrying a friend of his when they returned from Vietnam. And how that marriage fell apart, and resulted in tragedy when his former friend showed up on her doorstep with a gun and shot her, and their child, before turning the gun on himself. He then told me about how he came into his identity as a gay black man – not an easy role for someone in Baltimore. I asked him whether his family knew his sexual orientation, and he told me of an evening when his younger brother joined him for an evening out on the town, and they went to my patient’s usual hangout, a bar that served both gays and lesbians, and when they walked in the door, a friend of his came up to him, and embraced him warmly, and kissed him on the cheek. He described to me how his brother was offended, and called for a family meeting that following Sunday morning. His brother announced this revelation about my patient’s lifestyle to the family, and their mother stood up for my patient, saying to the younger brother, and the rest of the family, that my patient had always been an honorable person, and had served his country, and she would not allow anyone to question his lifestyle or choices. She insisted that they all respect him. Listening to him, I felt such admiration for this mother whom I’ve never met.

One of my standard questions that I ask all my patients is the number of sexual partners they have had. This question might seem irrelevant to someone who doesn’t care for HIV-infected patients, but the answer can have numerous implications for other infections and conditions to be watchful for, and the potential future risk of transmission, or complications.

This patient’s answer to my question? One.

One guy.

One guy who didn’t tell my patient that he was infected, even though he knew.

One guy who my patient stayed with for nine years, caring for him through the end of his life, and watching him die of complications of AIDS.

And, because of this one guy, who infected my patient without his knowledge or consent, my patient has lived a celibate, single life – not wanting to put anyone else that he might love, or be attracted to, at risk for the same misfortune that he has suffered. He’s not unhappy, in fact, he has always struck me as the most balanced and emotionally stable person I know. He has a full life, with lots of family, good friends, and plenty of activities to fill his days.

So, thanks to the EMR, I now know one of my patients better (in fact, I’ve been learning about a lot of my patients in the process of filling in the gaps in the medical record), and, maybe I’ll be able to convince him to open up to someone, and allow love back into his life. Without the EMR, I never would have had the opportunity to counsel him about the relative safety of becoming intimate with another person in 2012, compared with the greater danger of having sex with an HIV-infected person in 1995 or earlier, before we had effective antiretroviral therapies (ART) to control the virus.

These days, the medical literature is full of not only the benefits to the HIV-infected patient of taking
ART, but also the public health implications, as ART has been shown to reduce the risk of transmission of the virus.

So, I often find myself counseling my stable, well-controlled patients, who have no detectable virus in their blood, to engage fully in life. I feel very strongly that HIV should not rob a human being of the right to have a long-term loving relationship. And I encourage patients like this man to get back in the game.

Do you find that shocking?