Home > Medical/Health Commentary > The “if only” EMR

The “if only” EMR

The Happy Hospitalist has a great proposal to improve the utility of EMRs.  Right now, these systems are often plagued with what one blogger calls “Copy n Paste Gone Amok Syndrome.” Reams of redundant information is copied into the EMR, and physicians who want to extract the clinically useful information from a note have to expend a lot of effort to wade through the pro forma notations that are primarily there to satisfy E&M billing requirements.  If you want to get paid for that high-level patient encounter, you had best document each point of the x-point review of systems, and so on.  When every physician does this for a patient being bounced around to multiple specialists (or with frequent medical contact, generally), the length adds up.

Add to this the frequent proposals that some patient behaviour or another be tracked in the EMR by every treating physician, regardless of why the patient is there in the first place.  Some of this is probably a result of the trend towards overmedicalization of everyday life that we see in North America.  Some of this is probably a result of medical interest group politicking that seeks to enhance the profile/prestige/importance of their constituency.  Some of this is probably a result of the “what harm can come from another checkbox in the record?” mentality, coupled with the fact that this data can actually be useful to policymakers, researchers, and sometimes even patients(!).  Off the top of my head, I can think of proposals for medical monitoring (or notice-taking, or box-checking) of social markers as disparate as smoking status, BMI, domestic violence, seatbelt use, and texting-while-driving.

Happy’s open-source H&P would go a long way to restoring sanity.  Unfortunately, as he points out, the payment system isn’t too conducive to that sanity.  When every physician has to check all of those boxes in order to get paid… they’ll get checked, and then copied-and-pasted.

In some ways, his proposal reminds me of the way that record-keeping functioned when I worked for my campus IT department.  The required drop-down lists for all the data the “higher-ups” wanted to collect was kept in a separate part of each case record, never impinging on the employee-written narrative reports that contained only the vital information.  They got their data, we got to see what we needed about the case’s progress and past work history, without the former getting in the way of the latter.  Data collection didn’t excessively impede workflow.  Win-win.

Lots of people have rightly pointed out that EMR vendors would do well to design their products based on how medical practices actually operate, instead of assuming that medical practice should be shoehorned into the constraints of the electronic record.  For some good ideas, they need not look beyond their own industry’s analogues.

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