Electronic Health Records

Adoption & Implementation News

Does EHR design limit the critical thinking of physicians?

By Kyle Murphy, PhD

This week will include a fair share of praise for health information technology and its benefits for supporting efficient and effective care, but it comes on the heels of some harsh criticism by one California pediatrician who is arguing that EHR technology hinders the critical thinking of physicians.

“As a physician, I do not want my thinking to be limited in any possible way by a template that I need to fill out in order to create a note,” writes Charles McCormick, MD, FAAP. “Every patient is different, and not a single one of us fits into the same box. We are, unfortunately, dumbing down medical care providers just like we dumbed down our teachers.”

In his harangue of EHR use, the Stockton-area physician identifies two deficiencies in the current technology preventing healthcare organizations and providers from realizing the promised benefits of adopting these systems and services — a lack of interoperability and template design.

“Different record systems currently do not communicate with one another, although records can be copied and sent to another physician,” McCormick contends. “Hospital systems are substantially different from systems used in private offices and the systems used in our local hospitals are often strikingly counterintuitive and Byzantine.”

For the pediatrician and Associate Medical Director for Health Plan of San Joaquin, the EHR presents constraints for physicians looking to engage actively with their patients during encounters.

In my practice, I have been using a federally approved EMR for the past year, and I find that a significant portion of my thinking is directed toward how to record a patient visit rather than what actually happened in the visit. Previously, I had used a record-keeping system in which I recorded information in my own handwriting, and I would note those things that were important to me so that I could reference them later as I cared for my patient.

Today, I have to figure out how to get the important information into a box somewhere in the medical record. This usually means about an extra hour every day to make my notes meaningful. Mixed in with the important information is a large quantity of trivial or insignificant information that obscures what is really crucial. There is nothing concise about the modern EMR!

The not-so-subtle dig at meaningful use and certified EHR technology (CEHRT) is full of complaints about the effects of a physician adjusting his thinking to suit the electronic record rather than applying his critical thinking to providing a patient with the treatment best suited to the latter’s condition.

Apparently, the problem with current EHR templates is a lack of space for physicians to document those bits of information that do not conform nicely with check boxes and drop-down fields.

“We spend more and more time struggling to use a technology that actually limits the creative process and less time facing our patient and thinking about their problems. Applying an old cliché, we need to resume thinking out-of-the-box,” McCormick concludes.

As National Health IT Week begins, the pediatrician’s criticism is a reminder that EHR technology is not perfect and that its shortcomings need to be addressed and resolved.




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