Electronic Health Records

The electronic health record (EHR) will replace paper charts - a refrain that I have been hearing for at least ten years, but the volume of the clamor has been steadily increasing for the past five years. The noise is now nearly deafening, since the federal government is offering physicians financial incentives to adopt EHRs. The maximum reimbursement for expenses incurred to install an EHR (estimated to be up to $100,000 per physician) will be $44,000 paid over five years once some very stringent criteria are met.

The New York Times published an excellent analysis in Sunday Business this week: http://www.nytimes.com/2011/07/17/technology/assessing-the-effect-of-standards-in-digital-health-records-on-innovation.html?ref=business. “ …when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs.” Unfortunately, EHRs as now designed are cumbersome, slow and not at all aligned with the ways physicians and patients interact. I take notes while my patient and I chat. Since patients don’t relate their histories in a linear way, my handwritten notes will jump around a bit as I organize the story. Sometimes, in the middle of talking about sinus congestion, the patient will make an off-hand comment that a parent has an unusual, inherited disease or ‘when I was 10 I stopped breathing after a penicillin shot.’ With the paper record, I can seamlessly add this vital information to the family history or list of allergies. This is not so easy in an EHR. I am very familiar with an EHR offered by a very large company. Adding information such as this means closing down the history of the present illness window, opening the allergies or family history window and finding the correct tabs (and codes!) for this information. A less than diligent physician might not go to the trouble.

Software engineers are not physicians nor do they think like physicians. When attempting to document a past medical history in an EHR, I was unable to find “varicella” as a key word. The person writing the program figured that regular people use the term “chicken pox,” so that was the only was to enter the illness. I have an app in my pocket with key diagnosis codes – but even that information didn’t allow me to work around this barrier.

I’ll be sticking with paper records for now, even as I have embraced electronic prescriptions. The prescription vendor that I use won’t allow me to make a careless error and has a drug interaction and drug allergy systems that reassures me that primum non nocere (first do no harm). Any EHR will need to do the same for me to purchase it.