The patient looked angry and I felt his frustration. His voice was rising, “Why is the chart 54 pages long? My son has only been here five times!” In the olden, pre-electronic health record days, chances are the chart would most likely have been less than 10 pages. However, since the government takeover of medical records, this is no longer the case. When the government rolled out its meaningful use regulations and the now upcoming MACRA laws, the medical record got pumped up as if by a rapid infusion of body-enhancing steroids.
In the state of NJ, the law states that I can charge $1 per page to produce a copy of medical records for patients. Hence, the patient wasn’t upset by the length of the record but more the cost of producing it. When EHRs first appeared, the goal was to develop interoperability where all programs could communicate with each other. This would make the issue of copying records extinct. A treating physician could just go into the master data highway and retrieve whatever records are needed to treat the patient. This is a noble goal indeed, yet EHR vendors and lawmakers failed at achieving even a semblance of this shared data dream.
Despite the failure of interoperability, rules exist that enforce us to try to use these technological dinosaurs as if the goal is realized. We are required to record metrics that the government demands we put in our charts. In the dream version of these mandates, this data becomes readily available for third parties to harvest. In our current failed connectivity wanna-be systems, we must record these government-defined data metrics or be penalized. And we must produce reports and more reports and upload them to the systems of governmental agencies to ensure we are in compliance with the regulations. Much of what we are now entering into the patient’s medical record is no longer medical information. We must enter race, email, etc. Some patients get annoyed when we ask them what race they are. This is America — some don’t even fall into a race classification. Frankly, I do not care what race a person considers themselves to be. I recently witnessed a prolonged debate among a group of Egyptians as to whether they are Africans or Middle Easterners. It doesn’t change who that person is, and it doesn’t help me when a patient is having a severe allergic reaction to some unknown agent.
In the pre-EHR days, it would be easy to look up information in the medical record. You want to know what was discussed in the last visit? Just look at the assessment and plan of the previous visit and there it is. Now, we have things like clinical summary, medication reconciliation, etc., recorded into the visit noted. Some patient encounters can be up to 10 pages long, where in the past they were half a page.
That being said, I actually like electronic records. I am more a tech person than a paper and pen person. But, the systems we have these days are sub-par. And the data we are required to report are often irrelevant and just take up unnecessary space in the electronic chart. Performance-enhancing drugs are not allowed in sports and we should not inject our very important medical records with performance-enhancing data. Who needs to be told every single time an electronic prescription is sent that it interacts with grapefruit juice? We need real records that are medically relevant. Let the third parties go find their own data to mine and leave the patients’ alone.
Linda Girgis is a family physician who blogs at Dr. Linda.
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