There have been many recent articles about the challenges presented by electronic medical records (EMR) to both health care providers and their patients. Many of the criticisms have to do with the extra time needed to input information to the EMR system and the temptation to simply click buttons rather than providing detailed information. The major purpose of medical records is to provide information to future providers to assist them in diagnosing and treating medical problems.
The over-riding criticism of EMR, however, is the tendency to “cut and paste” information. This means that early errors in clinical information get repeated over and over again and can provide a false basis for medical decision-making. It also means that each time someone inputs information into the system, the same paragraphs are repeated. This means that finding any new information in the EMR can be a frustrating effort to ignore all of the duplicate information and try to tease out the pertinent information.
A good example was a recent review by me of emergency department records for a man who had symptoms of a heart attack. The initial paragraph about the reasons for his ER visit was repeated every time someone put in new information, such as lab results or other test results. In the 100+ pages of the printed EMR records, I counted at least 20 instances of the same paragraph being reprinted. Finding the important lab or test results in the midst of this set of records required great attention. So how is the busy physician or nurse going to find that information in the middle of a busy morning in the ER?
A physician writing about EMR made the following comment: “[i]n the past week I received a USB drive with 2402 pages from a hospital chart. It took me less than 30 minutes to scan more than 2300 of those pages and eliminate them as absolutely useless. Page after page of information was either downloaded automatically from a monitor or created for nothing more than to comply with regulations. Less than 5% of the chart contained potentially usable information (emphasis added).” Yet it’s that 5% which may mean the difference between good care and the death of a patient. Any system that makes it difficult to find the useful information in a medical chart is a system that needs to be changed.
