There has been a litany of complaints recently about how confusing electronic health records (EHR) can be and how flaws can result in diagnosis and treatment errors. An example is the possibility that the Texas Ebola patient was not diagnosed in the ER because the EHR entry about his arrival from Liberia was not seen by the doctors who treated him and sent him home. See [here][1] for a previous blog post on this issue.

A recent article in the New York Times highlights yet another complaint about the use of electronic health records (EHR). You know how we complain about teenagers who are so engrossed in their digital world that they ignore those around them? It turns out this is a potential problem with doctors, too. The cut-and-paste abilities of EHR means there is a huge amount of repetitive information that has to be picked over to pull out the key facts needed, such as in making a diagnosis. That means the doctor is often hunched over the computer screen trying to find that information rather than turning around and talking to her patient.

Every medical school teaches the importance of history taking. Indeed, some medical educators think it is the single most important subject to teach medical students. That history is to be taken directly from the patient, not from perusing another provider’s version of that history. Short-cuts, like having the patient fill our a lengthy health questionnaire, may save some time for the physician, but often that information is ignored. As the New York Times article said: “Force the doctor to take notes, and the doctor will usually remember. Ask the doctor to read, and the doctor will scan, skip, slide, omit and often forget.”

Asking others to elicit the history has the same pitfalls. In a recent case, the triage nurse in the ER noted that the patient had a family history of cardiovascular disease, but the doctor didn’t see this when he examined the patient and didn’t bother to take his own history. The result: the patient was sent home when she should have been referred to a cardiac workup. The Times article summed it up: “Like good police work, good medicine depends on deliberate, inefficient, plodding, expensive repetition. No system of data management will ever replace it.”

[1]: https://cmglaw.com/Blog/2014/10/Houston_Ebola_Case_Highlight_Flaws “here”