The latest Green Journal has an outstanding piece by Dr. James Bernat regarding the unintended consequences of the electronic medical record (EMR). I’ve used this blog and other venues to complain about some of these issues from time to time, but this paper summarizes all of them on once place.
I think one of the highest-level issues is that the clinical relationship has been transformed into a series of billing exercises, with documentation ever more clearly geared toward billing (and “quality”) requirements and ever more removed from human narrative.
What really drives me crazy in particular is what Dr. Bernat calls “pseudohistory”. This is when the EMR application takes a series of checkboxes and turns them into “narrative”. Example:
The problem is acute. The problem is constant. The problem is improved by nothing. The problem is worsened by exertion. The problem is . . .
When I see that garbage in a note, I know that I basically can’t trust anything written there.
Please read this essay!