Once upon a time . . .

Those words are probably in the Top 5 list for the most widely used words in history, but what do they have to do with EHRs?

Well, not much, if you need to be literal, but the tradition of keying into a patient’s story – or the narrative, to be more clinically precise – runs deep in medical history.  And it’s one area that has taken a hit in this age of digital templates and record-keeping.

According to this doctor, however, it’s time to revive the role of the patient narrative, and the trick for providers is to make the new technology respond.

To be clear, he’s no Luddite, wishing for some technologically simpler time.  Indeed, he begins his commentary with “the electronic medical record (EMR) is here to stay. Its adoption was initially slow, but over the past decade those hospitals that do not already have it are making plans for implementing it. On the whole this represents progress . . .”

Despite his acceptance of the new technology, he argues that “there is a problem: The EMR is trying to serve too many masters. The needs of these various masters are different, and sometimes they are incompatible, even hostile to one another.  These masters include other caregivers, the agencies paying for the care, and those interested in medico-legal aspects of care.  What can happen, and I have seen it many times, is that the needs of the caregivers take a back seat to the needs of the payers and the lawyers. The EMR is supposed to improve patient care, but sometimes it makes it worse. Physician progress notes illustrate how this happens.”

What follows is an interesting and compelling illustration of why, in his eyes, providers need to push back against the narrative reductionism, so to speak, that often comes with new health IT.

Money quote:  “The ease with which mounds and mounds of verbiage and laboratory data can be stuffed into a progress note may give the payers what they want, but it often does not give me what I want– and that is some evidence that all this information was processed through a physician’s brain and led to a carefully considered decision about what to do. I want a human voice, and that is getting harder and harder to find in the EMR’s stereotypic and bloodless documentation.”

The piece is definitely worth reading in its entirety.  Then let us know what you think.

Photo courtesy of UNE Photos via Creative Commons