Today I was reading a column by the inimitable Mr. HISTalk in which he argued that EMRs really can do a major disservice to patients. One way in which they do so, he suggests, is inherent in their design:
“EMRs try to turn freeform and sometimes tentative thoughts into dropdowns and template-driven generic verbiage that may destroy their original context (that’s what programmers do: impose order and create retrievable database information, so it’s not really their fault).”
I found this to be pretty interesting, because it highlighted a problem not discussed a lot in this space. To wit, it points out that dropdowns, templates and the like aren’t just frustrating — they’re actually forcing doctors to document care in pre-prescribed ways which may or may not suit the physician’s line of thought. After all, in a template-and-dropdown environment, there’s little room for thinking out loud, suggesting theories or making unorthodox observations.
Ideally, the notes physicians enter or dictate should represent the best of their judgment, but also their intuition. Not only is intuition necessary to determine the best course of care for patients, it’s a critical tool for divining when something is out of order, be it a test result, the patient’s current diagnosis or something in the history that doesn’t fit.
And here you have the essential conflict between EMR-driven medicine and “old fashioned” methods. As Mr. HISTalk points out, it’s the job of the EMR makers to normalize data such that it can be abstracted, shared and studied. But it’s the job of the doctor to solve the problem that shows up in front of them, whether it can be described easily using a template or not.
Now, I’m not suggesting, as many have, that EMRs can’t be evolved into tools which are flexible enough to both support physicians’ process. But I do think it’s important to focus in on issues like these, as they’re still very much in play.