VERONA, WI – According to electronic medical record (EMR) manufacturer, Epic Systems, the implementation of EMRs has improved the physical exam toward normal in 46% of patients in the hospital and 51% in office practices. Subspecialty practices show an amazing 82% resolution of abnormal physical exam findings outside of its own subspecialty. The most notable improvement came from orthopedic surgery whose patients had a normal cardiac exam 100% of the time.
Administrators who implemented the Epic EMR are very proud of these findings. Duke University Chief Information Officer Chip Dunkins, MD is not surprised by the findings and states, “We spent $700 million dollars on Epic’s EMR and crafted the ‘normal physical exam’ with such care that it would be unsightly and time consuming to change any of the findings from the template. Even without seeing a patient in 8 years, I can improve the physical exam and therefore cure disease.” He added, “I told my father that going into medical informatics wasn’t a waste of $300,000 of schooling, 3 years of residency, and 2 years of fellowship.” He also added,”See dad! I told you my work is important.”
Once an EMR is implemented, subtle chronic findings such as an Adie’s pupil, a 2/6 heart murmur, or a petechial rash are the first that are cured by Epic’s EMR. Within months, prominent murmurs, anisocoria, and the fine basilar rales of pulmonary fibrosis are no longer documented and these findings are assumed to be cured. And before year 3, it is not uncommon to have dense hemiplegia, limb amputations, and cognitive findings associated with profound dementia completely removed from the physical exam and replaced with a normal physical exam.
Epic spokeswoman Leslie Frankel discusses how cost and health are connected. Frankel states, “We at Epic strive for every patient in America to have a completely normal physical exam documented with every patient visit. If that costs the healthcare system trillions of dollars, we are prepared to accept that money.”
4th year Wright State medical student Darcy Nguyen has only known the benefits of computerized charting and the vast majority of the physical exam she reads are completely normal even though their problem list contains dozens of diagnoses. Nguyen states “It is encouraging that patients suffering from severely deforming diseases such as Proteus syndrome or Sturge-Weber syndrome can be described as ‘normocephalic…. And no skin lesions, rashes, petechiae, or ecchymosis.’ It gives hope to see that every disease can be cured by Epic if we get enough patient visits particularly if paired with less time to providers. Looking back at dictations from pre-Epic, patients always had things wrong with their exam.”
Orthopedic surgeon Kyle Broncho, MD states that he is proud to have helped resolve innumerable cases of aortic stenosis. “Just because I lost my stethoscope 2 years ago doesn’t mean I have to change ‘RRR, no r/m/g, no heave or thrill, normal S1/S2.’ How else could my physician assistant bill a level three follow-up?” asks Broncho.
