Yesterday I took the curmudgeon role on EMRs. It’s not the first time and probably won’t be the last. DB responded here. He had previously posted a wonderful essay on the art of history taking. Maybe it was unfair to use his post (which was not a rant against EMRs at all) to support my own criticism of EMRs. At any rate, his response served to point out that I rant about EMRs at the risk of being misunderstood (the spike in blog traffic with the help of Kevin was a bonus). So, here’s my attempt at clarification:
I regard electronic medical records in much the same way I regard the pharmaceutical companies---with healthy skepticism (questioning things, not believing everything the promoters say) but not cynicism (seeking every opportunity to knock them down).
EMRs have conceptual advantages that are very appealing. Making them work in the real world is problematic and filled with unintended consequences. It has to be done right. We’re not there yet. Most of us, anyway.
I’ve written before on the decline in basic clinical skills and cited many reasons other than the EMR. But templates serve the coders more than the clinician. Templates impede original thought and introduce challenges to the recording of a meaningful history. A good clinician can overcome the challenges but it takes effort---maybe some extra typing and editing. Templates are not unique to EMRs. We had them in the paper days. EMRs just took them to a new level.
Poor documentation and questionable coding, while facilitated by electronic templates, ultimately reflect on the physician.
My observations on EMRs are not scientific. They’re random. That being said I’ve seen some good electronically generated notes, but they’re in the minority. Most seem to have a low signal to noise ratio.