Monday, June 29, 2009

EMRs degrade the quality of clinical documentation

This article in the American Journal of Medicine explores some of the reasons. Repeated copying and pasting of other notes and template generated electronic clutter are two. Another underappreciated aspect is loss of the power of clinical narrative:

Another more insidious consequence of the copy-and-paste function has been the loss of the narrative. Because charts have become capacious warehouses of disorganized, irrelevant, or erroneous data, the story of the patient and the patient's illness is no longer easy to read or likely to be read. In a most compelling and perhaps unintended way, we are witnessing the “death” of the health record narrative, as many of us have known it. Others also speak of the loss of narrative in electronic health records, and with great concern because narratives form the basis of clinical decision making.

Daily documentation of the patient's trajectory, in prose, even when stripped of overt emotional content, is not just educational. It is humanizing.


I have yet to encounter an electronically generated note that effectively tells a patient’s story.

4 comments:

Anonymous said...

As long as the documentation is used to help the doctor/practice/hospital get paid, it will never be about the patient.

It's about the money.

Anyone ever read the nurses notes in the ICU? Pages and pages of nothing of consequence.

Clinical documentation should be called "legal requirements to get paid and decrease the risk of a lawsuit." Then patients would know what it is.

Clinical documentation stopped being about the patient the day that "documentation specialists" appeared.

christophil said...

Sadly medical records are no longer for documenting patient narratives. EMRs are for meeting coding criteria (99214 or higher) and shielding doctors from med-mal lawyers. Right?

R. W. Donnell said...

Anonymous,
"Clinical documentation specialist" is a misnomer considering what they do. They are really "administrative documentation specialists."

Christophil,
The medical record has been hijacked by the coders, the risk management experts and the performance measure police. Going electronic has greatly facilitated that process.

Anonymous said...

It's complete hipocrisy at the adminstrative level. All I hear about is how "patient centered" everything needs to be, and they do absolutely nothing about the fact that their precious EMR and it's worthless notes do nothing for communication that is essential for the patient.

Why do leaders do nothing? Because an emphasis on doing notes the right way might take more time (from the docs actually entering useful narratives, which is cumbersome) or money (paying transciptionists to transcribe lengthy dictations).

better to put your head in the sand while easily generated, highly billable notes of gibberish are produced. Pathetic. Nothing patient centered about it.