With the HITECH Act fully upon the healthcare industry, the push for the move to an electronic health record is on the rise everywhere. We’ve heard how it can improve patient safety, streamline processes, and even put all of the patient’s information in one place. In our piece of the industry, we hear about electronic records replacing some transcription positions, and we have had a lot of talk about physicians who are using scribes in place of MTs, with scribes having an expanded role.
A Doctor’s Perspective
In perusing the internet this past week, I ran across the story The Doctor vs. The Computer on a New York Times blog. The article is written by Dr. Danielle Ofri, who is an Associate Professor of Medicine at New York University School of Medicine and Editor-in-Chief of the Bellevue Literary Review. In it, she describes the challenge of putting information into a patient’s electronic record after doing his preoperative evaluation to see if he’s a good candidate for surgery. What she finds as she types the narrative trying to describe all of his medical conditions is that the electronic record has a 1,000 character limit for narratives.
A couple of the points that struck me were:
But there are huge trade-offs. Most importantly, the electronic medical record affects how we think. The system encourages fragmented documentation, with different aspects of a patient’s condition secreted in unconnected fields, so it’s much harder to keep a global synthesis of the patient in mind. What will happen to the tradition of thorough clinical reasoning?
The Value of the Narrative
I really want you to go read her entire article as it will open your eyes to the challenges physicians are facing as they attempt to make this move. When we talk about the value medical transcriptionists bring to the table in the way of being sure the narrative is still a part of the record, this is something to really think about. In addition, systems that only allow 1,000 character maximums really don’t leave much room to truly tell the patient’s story. If you think about that in terms of what we know as MTs and a 65-character line, you’re talking around 15 lines. Could you tell your entire health history in that? And what about the patients like Dr. Ofri’s who have complicated histories?
Is This The Future?
When I read things like this, it creates some real concern for where documentation in the healthcare environment is heading. To think that physicians are trying to reduce things by cutting corners in their documentation to create “more efficiency” is worrisome. And at the end of this blog, I was asking the same question as the physician, “what if there are complications?”
Perhaps more important is the question of what happens to “thorough clinical reasoning”? As the physician describes it, nobody is really going completely back through a record like they used to do with paper charts. At some point, all we will have are clinicians who have worked with nothing but the electronic record. Will this impact patient care?
Remind me why they call it meaningful use
Our world is changing and it’s changing pretty fast. Many physician offices are moving to the electronic record with a check system and some are also using scribes. In my own town, physicians are opting to sell their practices to large corporations or to the hospital so they don’t have to come up with the funds to go electronic. For the physician, that may make good business sense as they save the cost of investing in the electronic health record system. For the organization, it makes sense as it does streamline some processes, and there’s a government financial incentive for doing so.
My question is still: Does the way we are going about this make sense for the patient? I wonder if anyone is really thinking that one through. It sometimes makes me wonder who coined that phrase “meaningful use.”