Deducting from my extensive experience with EMR (electronic medical records), I believe it has advantages and disadvantages, like any product.For example, some users may become prone to copy-pasting and using templates that change very little with individual patients. See an example below:
All worksheets were followed as appropriate. Each diagnosis was stated precisely. There is no lack of a diagnosis justified. Functional impairment was mentioned. All remarks are addressed.
The onset of the skin condition was described, as was the course of the skin condition with any variation of symptoms over time, if any. Any treatment type and dosage, if found or used, was mentioned, if any. The frequency and duration of each treatment during the last 12 months, if any was found, was stated. The percentage of exposed areas, and entire body surface area percentage involved, were stated, if any. If any scarring or disfigurement was noted, this was stated, and if so, the scar examination worksheet was attached, if any disfigurement was noted - if none was found, the scar examination worksheet was not attached. If any acne or chloracne was present, this was stated, and whether it was superficial or deep, if found. Any diagnostic or clinical tests or photographs, if needed, were reported, if any.
However, there is little doubt that EMR is a much better solution than paper documentation overall.
References:
Obama proposing a massive effort to to make all health records standardized and electronic
Related reading:
Debate: Do Electronic Health Records Help or Hinder Medical Education? PLoS Medicine: http://is.gd/z9or
Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.
Templates don't have to be a bad thing. When I was a 3rd year med student I rotated through a family medicine group within a larger multispecialty practice. Their EMR had templates based on CC and anticipated severity of the visit.
ReplyDeleteIt would pre-populate the HPI with a mad-libs type story and offer reasonable options for each blank. Something like, Pt was in USOGH until X days ago. Complains of cough (with or without) sputum production ,,,,,,
The ROS would have a reminder of how detailed you needed to be for the anticipated billing level and offer all the anticipated ROS answers, you just had to click on the ones the patient had.
The Dx was prepopulated with a differential of the most common dx for a given presentation and the most common parts of the plan were in place along with reminders about follow-up care.
The key to making a system like that work was that the fields were just giant text boxes that prepopulated; you could delete things that didn't fit or you didn't want to ask.
Also, the templates were fully customizable so they had different ones for well-check/physicals based on age and gender that prepopulated all relevant screening/vaccine information based on USPTF guidelines.
So, yes, templates can be dangerous if you're not doing the things in the template, but they can be a great boon if they remind you ask certain questions or order certain preventative measures which you might overlook during a busy sick visit.
Agree. Thank you for your comment.
ReplyDeleteI looked forward to using the EMR as I thought it would be an improvement over the paper system. However after 2+ years on an EMR in a mostly ambulatory setting, I am not sure that the EMR is better. Where is the data to support its superiority? In the meta-analysis that I reviewed, There is some evidence that EMRs will help you choose the right anti-infective. Some studies showed less medication error and others showed more error. One study even showed increased mortality in a Peds ICU. In primary care the template is good if you have only one problem, but most patients have several. What about the cost to physicians who are doing the data entry - adding as much as 5 minutes more to each encounter? In primary care this is untenable. The system is only as good as the data that goes into it.
ReplyDeleteEMRs are not that efficient. Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.
ReplyDeleteVery nice said comment. Agree with you that EMR are not fully optimize. EMR currently running in hospitals has problem now and then nurses has issues with them all the time, like recently a US senator was about to be killed because of EMR, the system was showing that the patient do not need the medicine but the patient health was getting worse and worse but the problem was solved by the technicians. EMR is still in a state of development.
ReplyDeleteI disagree... EMR has many advantages, for instance paperless healthcare records relieves the burden of maintaining sheaf’s of paper for endless number of years, the doctors have instant access to health records at any time any place. The EMRs provide doctors the option of interacting with fellow doctors through a computer, without referencing hard copies of patient records.
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