Eliminating the Inconvenience by Pat Conrad MD
Ordinarily I flip through Family Practice News with minimal interest, in a generally indisposed status. Every issue they have some new study or op-ed co-authored by Neil Skolnik, MD, and on EHR matters, he is usually joined by Chris Notte, MD. I don’t know these two, and maybe they are actually nice guys. They both have fingers in other EHR pies and data-sharing apps according to their insert bio’s, and they’ve produced a number of articles very accommodating toward the idea of EHR’s for all (in fairness, they have given more recent commentary to all of the problems these damn systems cause). This article caught my eye, wherein they show a case study of how EHR’s are actually harmful to patient care. In so many words, they tell how a patient was presented grand rounds-style, who told her story to the assembled crowd. Then they presented her case strictly from her electronic record, and the story was completely different. You have to love this sentence: “This was no case of mistaken identity or registration error. The chart presented at the conference did belong to the patient, but the story told by the chart was wrong.” What organized medicine (looking your way, AAFP), Big Insurance, and Big Government is destroying on its way toward greater population data manipulation is beyond wrong. I highly recommend you read this article for yourself.
The problem with the current medical world is fragmentation; and the EHR contributes to it, doesn’t help it. I think the ultimate useable electronic patient history will be more like a Wiki document – with entries and subentries on different illnesses and their course – a CONVERSATION of a sort.
The enemy of non-human record keeping is the inability to parse and correct inaccuracies. The universal law of data errors says that ONE entry of PPD POSITIVE trumps 30 entries of PPD NEGATIVE, even if the first entry is a clerical error. Pretty soon, there will be FIVE entries of PPD+, then TEN, as each person regurgitates the McChart information. Who wants to bet that this patient gets INH? Unnecessarily, and for no benefit? Betcha dollar (s)he does. “We don’t suspect TB, but we’re treating the chart to cure.”
I saw a patient in a small ER who had been diagnosed recently with an advanced hepatobiliary cancer. His initial oncology consult 2 weeks previously was available in EPIC. Through the 7 or 8 pages of electronocrap, there were 2 hand typed sentences regarding the history. The template exam was all checked as normal ignoring the patient’s jaundice, ascites and abdominal mass. There was no conclusion, discussion or plan ! How can any clinician call EHR junk medical practice?
This is what happens when you are forced to put patient histories into boxes.
Put patient histories into boxes – and you pretty soon put the patients into boxes, too.