For all of EHR ’ s benefits , over an eight-year spread from the time I was a third-year medical student to now in my third year of private practice , I ’ ve seen electronic medical records devolve from its initial use as an aid to maximize efficiency . Instead , it has turned into a hodgepodge of patient data , stripped from any real information and of utmost concern , stripped from its humanity . Moreover , EHRss no longer aid in efficiency — for every one hour spent in patient care , two hours of EHR tasks are generated .
Just recently , I saw a patient in clinic for an ER visit follow-up . Reviewing his ER note before I walked into the exam room , I tried to make sense of the 10-page document and could only find these items of value : Duration : 4 hours Location : left lateral ribs Provocating factors : movement , twisting , palpation Palliating factors : rest Meds : ibuprofen prior to arrival Assessment / plan : Left lateral rib fracture # 7-9 , follow up with PCP When I walked into the room , I apologized to the patient . “ I read your ER note , but I ’ m sorry — I ’ m not quite sure what happened ?” Apparently , the patient had fallen down his stairs , caught his hand in the banister and somehow crashed on his ribs . None of that had been relayed in the note .
Instead , what happened was a provider became too click-happy following the set template in an effort to provide enough data to meet insurance criteria for reimbursement , rather than focusing on providing real information on the events that transpired . With a more discerning eye , I started reading notes I was getting from other facilities , the patient ’ s old records from other primary care providers and ER records — all with the same trend . All data with no actual information .
What has happened to our physician notes ?
Is this what we ’ ve been reduced to ? Clicking the right keywords in pre-formulated text fields so we can meet the minimum criteria to get paid ? Has the profession of medicine turned into churning out glorified EHR technicians ?
The original intent of a physician note was so we could relay what happened if we have to remind ourselves of events in the future . Now , we get attachments of reams and reams of meaningless vital signs and patient education handouts to filter through in order to get to the high yield information , if there even is any .
Looking toward the future , what is going to stop physicians and other healthcare providers from being replaced by artificial intelligence like IBM ’ s Watson ? A patient can easily type in / tell Watson what their symptoms are themselves , Watson can prompt additional follow up questions and eventually come up
with a diagnosis without our input — are EHRs just facilitating the demise of medicine as we know it , as my predecessors prophesied ?
I ’ d like to believe that patients still want that human experience when coming to their health care providers for care . And I fully realize just because the notes are not ideal does not mean patients did not receive ideal and appropriate medical care .
But I propose we are devaluing our expertise by reducing our thinking to preset text fields . We are catering to the whims of insurance companies by creating a note that checks off those checkboxes for reimbursement purposes . We are inviting automation of medicine through EHRs through our pointand-click love affair .
We need to take back control of this very important and useful tool .
So the next time you sit down to write that note , think to yourself , “ Am I just documenting data , or am I relaying actual information ?”
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