Practice Perfect 897
Technology & Podiatry —
The Ever-Changing Times

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Jarrod Shapiro, DPM, FACFAS, FACPM

Practice Perfect January 30, 2024

Hello from the Internet ether! It’s been a busy week in my private practice. We are in the process of converting from one electronic medical record (EMR) system to a different one, and this change has me thinking about the amazing changes that have occurred over the time I’ve been in practice.

I graduated from podiatry school in 2003 and residency in 2006. So I’ve been in practice about 17 years and as time goes by, I’m increasingly becoming the more “senior” person. As someone who was born in the 1970s (I’m in my early 50’s now) I’ve been witness to the Internet explosion and the endless changes resulting from this technology. In fact, for the first 18 years of my life, there wasn’t an Internet – isn’t that hard to imagine? When you wanted to read something, it came in the form of a book or magazine, not a PDF. When you wanted to find out information, you might read an encyclopedia rather than Googling. I actually learned how to type on a typewriter!

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College for me saw the beginning of the Internet explosion, but it was relatively rudimentary at the time. My first computer was a Commodore Vic 20 (as in 20 kilobytes), and it had a tiny dot matrix printer with paper like what you’d see at a gas station today. The Internet was so slow that we would click to go to a website and go do something else while the page loaded for several minutes. When we wanted music, we would download it on a service called Napster. We would queue up a list of 10 songs, start them downloading, leave for class, come back at the end of the day, and those 10 songs would have just finished downloading!

As we all know, things are much different and so much better now. Information is at our fingertips. The world is interconnected, and we are glued to our phones. The same thing is true in medicine. Technology is playing a huge role with EMRs completely replacing the paper chart. Similarly, paper prescriptions have gone the way of the dodo bird (I’m pretty sad about that one). In fact, easily the majority of my patient-related clinical activities are spent at a computer rather than in front of patients. That’s NOT an improvement.

I’m part of a group practice, and we are in the process of converting from one (horrible) EMR to another (promising to be excellent) one. You might think that at 51-years-old I’d be pretty set in my ways and uncomfortable with the change. However, after spending the last few years suffering through a truly poor EMR, I’m ready for the change. The new EMR promises access at any time, fast functionality, the ability to create protocols and attach images, among other advantages. Adding images to our charts will be easy and will not cause the system to crash. Charting a patient’s information also promises to be faster. When I first started practice as an associate to another podiatrist, furiously scribbling patient notes on paper, I would never have thought the technology would have improved to this level.

The holy grail of EMRs is to have a system in which a note is completed before the doctor leaves the patient room. That’s never been the case for me. I’ve never liked bringing a computer into the room during a patient encounter because I was concerned it would obstruct my creating a trusting relationship with patients. I can’t even imagine how many chart notes I’ve created over my 17 years of practice and how many hours of non-patient care time I’ve spent charting. I’m hopeful that my charting experiences will be very different going forward.

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Perhaps the real holy grail would be not having to write a note at all. Colleagues of mine at Kaiser Permanente are now using a system in which an AI program on their phone records the encounter and creates a chart note, eliminating any non-medical conversation. It’s amazing! In this case, I’m ok with big brother watching over me.

Will our conversion to a new EMR be everything I hope? What will a patient encounter look like 20, 50 or 100 years from now? As technology evolves, what effect will this have on physicians and the doctor-patient relationship? It’s anyone’s guess, but based on the last two decades, I’m sure the next two decades will look even more different than when I first started!

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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