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How EMRs Can Make Physicians Look Dumb

Two examples were presented at a recent conference. One was a cut and paste propagation of a minor problem. The other was an EMR problem related to templates.

  1. In the history, some doctor at some point wrote “patient deeniied abdominal pain…” That misspelling was likely related to heavy fingers on select vowels. This misspelled phrase found itself transmitted on multiple entries. Clearly cut and paste. And likely the patient was never asked about abdominal pain by any subsequent doctor. The record suggests the physician knew how to spell “denied” because it was spelled correctly elsewhere. What this cut and paste does reveal is that the doctor ignored the question. Similar to the physical finding “WNL.” Some believe that stands for “Within Normal Limits.” Others believe it stands for “We Never Looked.”
  2. An ob-gyn practice uses an EMR system with templates specific for ob-gyn patients. That would presumably mean it would be limited to female patients. Well, one ob-gyn took care of a female patient. Her husband was in the room and had some dermatologic condition – I can’t recall exactly – but it probably was a skin tag. Something minor. The husband asked if it could be removed. Sure. And like a good doctor, the ob-gyn entered documentation of the procedure into the EMR. The doctor entered free form text and took no further action. But the EMR assumed that all else was WNL. So, it included “No recent vaginal discharge” in the Review of Systems. Well, it would be unusual for a male to have vaginal discharge. So, “No recent vaginal discharge” is technically accurate but mostly because there is “No recent vagina.” Not sure the best way to counter this other to enter that this patient was a male and any no affirmative Review of Systems was performed. Then you’d look smart even when the EMR is dumb.

What do you think?

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By |2017-07-14T11:14:35+00:00June 24th, 2016|News, Uncategorized|7 Comments

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Retired

The issue of cut and paste or checking off boxes in order to get through all of the laborious screens of an EHR are well known. They are unfortunate. But the are a product of the requirement to check boxes in order to demonstrate quality in order to be reimbursed. The result is less quality, and increased costs. While EHR systems have the potential to improve care, it remains potential. Current systems were not created with the physician patient relationship in mind. Therefore the laborious documentation of things that are not related to the patient visit or “care episode”, and… Read more »

Ron Kirsner

I am a psychiatrist and do not use an EMR, but some of my colleagues do. One interesting thing happens. When a client comes in with”panic attack”, their documentation will suggest that he or she has experienced all 13 of the 13 criteria for a panic attack (dizziness, globus, chest pain, shortness of breath, etc.)

I don’t think I’ve ever had a patient report all 13 of 13 symptoms in my 18 1/2 years in private practice. So it does cast doubt on exactly what the clinician means when they check off that box in an EMR.

Michael M. Rosenblatt, DPM

I kept my medical/surgical records by typing on a laptop computer, which I always had in either my lap, or on a nearby table. I had some “prepared” files, like an “outline” of an H and P, either “short or long form”, depending on the circumstances. I had other prepared files as well, but always left space to add to them. After the copy and paste of the outline, I filled in remaining issues as I went down the paste form, filling in issues like allergies, previous operations, etc. The most interesting feature of this method of keeping records is… Read more »

Joe Horton

EMRs won’t make things easier until real AI gets applied to it. That’s bad news and bad news: medicine has allowed itself to get hobbled by EMRs by accepting them as inevitable. And when AI comes along, it will create chaos by telling doctors what they may and may not do. That translates to being treated by a computer, the doctor being only a technician who does its bidding. The final insult is the fact that there will be no privacy with EMRs–they will be eternal. Dr. Rosenblatt’s paeans to the contrary, I see nothing good about EMRs. Surgical center… Read more »

Michael M. Rosenblatt, DPM

As Doctor Horton said, a reasonable argument could be made that using a laptop to type medical records is not really EMR. In fact, we used regular medical charts, cut out typed medical record segments and glue-sticked them on to the charts. We just printed out op-reports and put them in the charts as well. I designed all my own “prepared” files. If there is an advantage to this system (and I think there are), it is in reducing the number of employees otherwise necessary, never being behind in chart notes and having them immediately available to send to the… Read more »

Anon

Many physicians who accepted “Stimulus” monies for EMR have received precisely what they paid for – Extremely Mediocre Reputation (EMR). Thank you.

Anon

In fact, EMR has been upgraded to EHR – Extremely Hideous Reputation.