Adopting the EMR: trading one set of problems for another

A recent review on the impact of the electronic medical record reminds of a sobering fact: that despite years of wishful thinking, research findings have been disappointing. It would be generous to say they have been mixed because by and large the positive findings have been confined to soft and non validated surrogate metrics. As suggested in the title of this post the EMR seems to create as many problems as it addresses. From the review:

Electronic provider order entry processes may lower the chance for errors based on the legibility or misplacement of paper orders.2 Other types of errors, for example, automatic renewals, cancellations of orders, and inappropriate dosing of medications, may actually increase with the EHR.3 Cut-and-paste options also increase the risk for errors in documentation.4 Computer systems are vulnerable to malfunctioning hardware and software and may run slowly. In addition, access could be difficult in a busy healthcare setting.5...

The primary care physician evaluating the multitude and diverse problems of medically complex older adult patients is especially vulnerable to the inefficiencies of EHR utilization. Check-box features and the automatic importation of laboratory values and medication profiles can lead to “note bloat” and boilerplate documentation that can obscure important clinical findings from the reader.6,7

The boilerplate “note bloat” referenced above is the EMR's answer to the doctor's handwriting, trading one form of illegibility for another.

The EMR is but one of several “systems” (e.g. the hospitalist model, rapid response teams, performance measures) which, though touted as solutions to various health care problems, have one by one been disappointing when subjected to scientific scrutiny.