Electronic medical records need to better focus on patients

The biggest problem with today’s push for electronic medical records is an archaic user interface.

Physician Alexander Friedman, writing a scathing essay in The Wall Street Journal, agrees.

Today’s electronic medical records are written for the benefit of insurance companies, which scrutinize each doctor’s note carefully for billing purposes. But, as Dr. Friedman astutely points out, “thorough, efficient billing doesn’t translate to better care.”

It’s gotten to a point where some doctors print out pages of data to bring to a patient encounter, or scan in dictated notes; both of which defeat the purpose of digital records in the first place.

There are scores of electronic medical records competing the gain market share — but each fails to communicate with one another, and all are burdened with a user interface circa Windows 95 that impedes clinical care.

It’s imperative that we divorce charting from medical billing, update interfaces to today’s standards, and return to why doctors write in the medical chart in the first place — to easier treat and benefit the patient.

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  • paul

    the top 2 priorities of medical charting, whether it be handwritten or emr. number one, make sure all the right checkboxes are checked for billing purposes and to be compliant with e&m etc, with pressure coming from the boss to pull in as much reimbursement as possible and from the government to not document fraudulently. number two, to jot down disclaimers all over the place pertaining to history/exam findings or various noncompliant behaviors by the patient to try to scare off the lawyer demons.

    until those two things are reformed, using the chart to document pertinent information about the encounter with the patient for the end goal of benefiting the patient will always be a distant third.

  • http://Blog.trialdox.com TrialDox Team

    Thanks for the thought provoking post, Kevin.

    We would submit that the biggest problem facing EHRs and PHRs is not archaic user interfaces (after all GMail initially had an archaic UI), but the fact that EHRs and PHRs have not been designed to solve a specific problem that providers need to have solved. If this were the case, our hypothesis is that EHRs would not be a “push” product in the market but instead a product with strong “pull” from end customers.

    Perhaps the root cause of the situation relates to forces outside the providers?

    We wrote a piece about the value of PHRs and EHRs here that may be of interest to readers: http://blog.trialdox.com/?p=217.

    Food for thought and welcome your comments!

  • ninguem

    Have you seen this?
    It’s been around for some time. Pretty much sums it up.

  • DocLemmon

    We need a hybrid system. An electronic record to track labs, immunizations, referrals, med list, SH, PMH, FH etc. Track the semi-static stuff and stuff amenable to tracking.

    The notes however could be dictated and on paper as before. If you want a note in the EMR, no need to even mention the Meds, SH, PMH, etc in the note — its in EMR already and only needs to be mentioned again in the note in specific situations. The note could be just a note, the physicians thoughts and exam findings and plan, no other repetitious crap just clutter up and obscuring the important part.

  • BladeDoc

    Your post is spot on. The more that an office or progress note becomes an invoice the less actual useful medical information it conveys. For example, could you figure out what was actually wrong with your car if you didn’t talk to the mechanic but only read the bill? Sure, you’d know that they replaced Part # sldfuoe345d and it cost $200 but so what?

    The same is true of medical information. I often need to call by consultants to figure out what their plans are and why after reading their perfect 99233 note in the chart. Because, although it contained all the necessary information to bill it contained no useful information on what the person actually thought.

  • Rich Lewis

    I am a family physician in practice for 13 years. I have a huge successful practice. Six years ago, I delivered babies, went to 2 hospitals, 3 nursing homes, did the occasional but necessary house call and saw 30-35 patients a day in clinic. I have excellent patient satisfaction and I known my care is quality. Even with the b.s. “quality measures” currently I score well. I use to have 1 nurse. Then came the computer(made exclusively for big brother), high co-pays/deductibles,and “quality” reports….now, no deliveries, no hospital care(now use hospitalist), no nursing home care, 17-20 patients a day, 2 nurses, 1 m.a., and a P.A.. I not only have stopped doing house calls, but I stopped almost any speaking to anyone after clinic because of pure exhaustion. I make more than ever. I just gave my notice as I am pursuing anything that doesn’t take on the role and responsibility of primary care. I blame the computer for most of the mess. Sincerely, One angry, resentful, but relieved MD

    PS- I cannot see how any caring primary care physician is not going to burn out with the BS that is happening.

  • Jann

    My doctor uses electronic records. They called me the day after my last visit to tell me my daily dose of Coumadin should stay the same. I have been an RN for more than 30 years. I have never taken Coumadin in my life and told them so. They wouldn’t believe me and argued with me for 30 minutes, then called my pharmacy, which confirmed that they have never dispensed any Coumadin. The doctor’s office then blamed the software for the error. I have zero confidence in electronic records.

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