Like many physicians, Stanley Wainapel is having to learn new ways of documenting patient care as Montefiore Medical Center implements a new electronic health record system. He faces some unique challenges in the switch over, however, because he's spent the past 20 years functionally blind-the result of a progressive retina degeneration disorder diagnosed when he was a child. He's been using computers since the mid-1990s. Screen-reading software lets him navigate the Web and reads him his e-mail at up to 400 words a minute, and he can type up a storm while his computer reads his work back to him. "It's less impressive to some that I'm a doctor than that I can type," he says. He's developed a host of templates and shortcuts for the software he uses to save him from having to mouse. Testifying last year on EHR usability before an Office for the National Coordinator of Health Information Technology workgroup, he warned the industry not to become too enchanted with icons and graphics-heavy interfaces, which just complicate life for those who can't see. EHRs that can accommodate people with disabilities may actually work better for everyone. "Look at audiobooks," he says. "They're a marvelous resource for people with vision loss, but you can also read them in the car during a long commute. There are curb cuts at corners so that people in wheelchairs can get into the street, but if you're a Mom with a stroller, you're happy they're there."
I will have to get my screen reading software to interface successfully with the various screens. Right now if I have to write up something, it's not a problem, but since we switched to the new e-mail program, my secretary has to read me my e-mail, which is annoying because I prefer to do it early in the morning.
When you spend a lot of time at the keyboard, you sacrifice the doctor-patient interface. Entering the data takes more time than seeing the patient. I don't like at all that you have to type this stuff in while you sit there. I maintain eye contact with my patients. I want to listen to them. If I had my choice, I would type everything afterwards, or have someone else type it in.
On structured data
I will memorize templates and panels and it will become an algorithm in my head. Doctors do that all the time-I just have to do it without looking at it. You learn where things are in the program.
On new vs. old
I dictate to a dictating service rather rapidly. I can do that with the patient in front of me, so they know what I'm sending to their doctor. I could do that with voice recognition technology, but I would have to talk slower.