Electronic Medical Record (Oh Doctor...)

This week's issue of JAMA has a commentary essay about the new Electronic Medical Record system. I'd have to say that it's right on the money for how inconvinient sifting through any chart is these days. The essay is available here for free and is written in a format that really drives the point home! (highly recommended)

EMR (Electronic Medical Records) is the new standard in medical technology. Basically, hospitals are hoping to have the entire medical record of patients available on the computer system, including all notes written for that patient. You can see the potential benefits, however, the idea has run into a few obstacles:

While EMR is highly efficient in producing notes, virtually all of its notes are longer, recombinant versions of previous notes. Even notes of different authors are morphed by EMR into clones of one another. As physicians have become more adept with the time-saving features of EMR, their notes have been rendered incapable of conveying usable information by their bloated and obfuscated nature.

For one, the notes never change. The longest note I've seen thus far here was seven pages long. SEVEN pages for a daily progress note. By a Doctor!

Moreover, EMR encourages everyone to copy-and-paste the notes of everyone else so that notes become the same from author to author as well as from day to day. Even consultants are assimilated into the oneness of the EMR Borg. A cardiology consultant recently copied-and-pasted the intern's note into his own, even including "consult cardiology in AM" in his recommendations. Perhaps he meant consult a more thoughtful cardiologist.

I'm all for making the intern's job a little easier (actually, no I'm not!) but this is really starting to get ridiculous, not to mention, downright dangerous.

For example, I am aware of a case where a patient expired due to what the team thought was a Deep Vein Thrombosis that traveled to the lungs. The team was aware of the DVT and were treating it appropriately, however, the intern's notes make no mention of the possible DVT. They were continually copied and pasted. The doctors who are now being sued have very little evidence to back them with no documentation.

It should be pointed out that EMR has some laudable aspects. Notes can be created quickly with minimal cognitive effort, and their impressive length implies diligence and attention to detail.

"Minimal cognitive Effort" is the correct term here.