Electronic records no panacea, doctors say
Moving from paper to electronic medical records holds tremendous promise for greater efficiency and accuracy, but the new technology is not a cure for all that ails modern medicine, two Boston doctors write.
Dr. Pamela Hartzband and Dr. Jerome Groopman of Beth Israel Deaconess Medical Center, writing in tomorrow's New England Journal of Medicine, warn that computers make it too easy for doctors to lose focus on the patients before them. Residents and doctors can cut and paste one another's notes into the record, sacrificing the benefit of fresh eyes looking at a patient and distilling what is most relevant. Lab test results can flood the record with no selectivity on what matters for the current problem.
But the most disturbing effect of digital records happens in the examination room, "to patients who, during their 15-minute clinic visit, watch their doctor stare at a computer screen," the authors write.
Not only is the patient put off, but the doctor is less able to think through a problem when not observing a patient. Groopman's book "How Doctors Think" analyzed the common errors in thinking that lead doctors to misdiagnose patients.
"Practicing 'thinking' medicine takes time, and electronic records will not change that," Hartzband and Groopman write in the journal. "We need to make this technology work for us, rather than allowing ourselves to work for it."
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Elizabeth Cooney is a former
health reporter for the Worcester Telegram & Gazette, where she also was a
business reporter and an editor. Earlier in her career, she edited medical
books and journals at Little, Brown, and worked for Boston magazine.Boston Globe Health and Science staff:
- Gideon Gil, Health and Science Editor
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The main problem with labs and other results cluttering the record is poor design. Many hospitals in the rush to put something out do not go through an exhaustive process to design every form and screen to put the right information in front of the clinician. There is also the issue of allowing exploding notes into the design. For example, one of the more popular EMR programs uses a note type macro where you can produce with a couple of mouse clicks a multi-paragraph note that details a normal review of systems. It leads to a lot more being documented that what was actually done. I detailed it in a post recently.