Bear with me here…but this is exactly why electronic medical records won’t do much if any to solve healthcare problems. Lay people think that computer systems in medicine look and function like the apps that have changed how we communicate and do business in our everyday lives. That’s very far from the truth inside hospitals and doctor offices. The second you need the system to function as a billing system is the second it stops solving real doctor/patient problems and has severe issues with usability and findability.
This well-writtend editorial says what many of us feel but had difficulty articulating: it is easier and faster to write your patient note in a paper chart. So why bother with a computer ?
Obvious would be that storage and retrieval of old information is easier with an EHR. Also, storing piles of charts is expensive and inefficient, not to mention legally problematic when very old charts disappear.
So what is not to love about EHRs ? This is what Dr. Friedman had to say:
A prenatal record might be five or six pages in handwritten form. The electronic records stretched for twenty pages, sometimes longer. Laboratory results by themselves ran pages. Each chart required important information to be painstakingly sorted out and reassembled in a meaningful way.
This strikes me as realistic. Whenever I get a note from a referring physician, the overwhelming amount of boilerplate jargon around the medical history and examination makes the small nugget of useful clinical information hard to find.
And while a dictated letter or note would reflect the doctor’s thinking, it seems that effort required to constrain the patient’s data into unwieldy “templates” exhausts the physician to the point where he or she is only able to donate a skimpy phrase or two to describe the patient’s actual problem.
Dr. Friedman puts it quite honestly
The problem with the technology is simple: Doctors and nurses use it to communicate with insurers, not with each other. A traditional note in a paper chart described the patient, what was wrong with him, and what needed to be done. The new electronic notes tell the insurer a doctor fulfilled criteria to bill for a service.
This is why I still dictate my notes, but store them in an EHR. Maybe I could “upcode” some visits and make a few bucks more (not that many, anyway). But I don’t think I could survive the stomach pain of repeatedly seeing my patient notes turned into a soup of computer-generated babble.