The growing literature on electronic records seems dominated by those who resist change, that is the majority of people! Most human beings dislike change. We prefer our comfort zones, doing things like we have always done them.
In the South, we often hear, “If it ain’t broke, don’t fix it”. When we hear that, we assume that the fix is usually worse than the problem. Those who object to electronic records, in my opinion, make that assumption. They assume that our antiquated, difficult to read, more difficult to find, and often duplicated medical records are quite good, thank you very much.
So I offer my first postulate – our current non-electronic medical records SUCK!!
Have you ever waited hours to receive a hospital chart, then receive 3 volumes, then have to read through many pages to find the relevant information? I used to do that. We all became good at that skill, but it took much time. As residents we had time (of course we worked 100 hours each week), but do we really have that much time today.
Readers know that I attend frequently at a VA hospital. I recently read some notes I wrote in 1999! The VA medical record now has over 10 years of data.
How does that help me?
- I can easily search old labs into a worksheet and see trends
- I can quickly find weights and graph them
- Discharge summaries are available from throughout the system – not just our VA
- Outpatient notes – the same
- Pharmacy records – with dates so that I can find the note associated with a medical change
- Xrays available for review from any computer
- Ancillary notes
- Old electrocardiograms
- Daily listing of meds and labs allow me (as the attending physician) to quickly review a patient’s status without ever looking for a chart!
The VA made this change prior to most other health systems. The change has worked.
They made the change because the medical record system really was broken. They made the change because it helps us provide better and more coordinated care.
So I am frustrated by the many blog posts attacking electronic records. I doubt that anyone would want to subscribe to a monthly compendium of my handwritten blog posts delivered by mail. Yet many of you happily read this electronic record of my musings.
My academic colleague, Dr. Danielle Ofri (NYU), wrote this piece for the NY Times – The Doctor vs. the Computer
In it she tries to make the point that the new ways are not better. Sorry, Danielle, but I disagree. I remember trying to decipher other physician’s handwriting. I remember the frustration of the lost chart. I lived through the fragmentation of records, with each subspecialist keeping their own record and sometimes sending me a letter.
Handwritten records are broken and electronic records are the fix. We should work with the developers to make the records work better, but going back to papyrus and pencil is not a realistic option.
We physicians must embrace technological advances in records just like we overembrace the technological imaging advances.
I would go so far as to wish for one common EMR for the entire country. Patients would get better, less duplicative care.
