by Stuart Sutton, MD
Our very large and very integrated health care system is plowing ahead with EMR implementation. All the offices are gradually converting from paper charts and all the hospitals have completed the process.
As a member of one of the last offices to be converted to the EMR, I’ve had the pleasure of patients being assured that the notes were sent to me (albeit via the EMR we are not yet using). I’ve come to accept that notes which I do receive from consultants who use the EMR (or indeed their own and different EMR) will be voluminous reams of boilerplate intended to maximize reimbursement and provide optimal medical-legal protection. The notes may also contain information of use to me in coordinating my care of the patient although such data may be so well hidden as to escape detection.
Regardless of the advantages claimed to exist within this Bataan death march of coerced changes in our practices, one subtlety of the paper chart is gone forever; the expectation that your note will be seen by the next physician who writes in the chart.
When I round at the hospital, I have immediate access to all the notes on the patient but may or may not opt to review them. Furthermore, as I previously indicated, the usefulness of these has been seriously degraded by their original intent having been hijacked by other priorities.
With a paper chart, of necessity, I will have to see the note of the physician who documented their visit just before me. And the same will be true of the physician who comes after me.
Resourceful note writers will have taken advantage of this by boldly writing as well as underlining any points they want to be certain are seen by those coming after them. This might relate to a diagnosis, a new symptom, or a suggested test. Indeed, even just the parts of a note in your peripheral vision will catch your attention with a diagnosis or some other finding that has been documented that may be highly relevant to the patient’s care. This unique aspect of communication is lost when working with an EMR.
With an EMR, the need to consciously choose to view a note actually discourages physicians from the process. Wanting to merely “glance” at a previous note requires signing on, selecting the patient, opening up the relevant screen, selecting the pertinent note, and then scrolling through the documented information to find the desired section. Not really a system that optimally facilitates physician communication.
This train has left the station and I don’t expect to be able to get off; there is too much of a commitment from the powers that be who hope to achieve their goals with an EMR. Sadly, the initiative seems to impair rather than improve many aspects of health care delivery.
Stuart Sutton is an internal medicine physician.
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