No doubt completing these charting requirements are simplified for today's nurses, but these nursing notes provide lines and lines of very little of substance for doctors to read, read exactly the same from patient to patient (and hence are ignored) and once something is found (like the social issues noted), no description of the issue is provided.Aspects of the new electronic medical record was not made for doctors or our patients, but clearly for quality assurance administrators. Thanks, folks.
Tuesday, April 29, 2008
The medical record has been hijacked by non-clinicians
And the electronic medical record has facilitated the process. Dr. Wes weighs in on the electronic nursing note: