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Why I Hate Electronic Medical RecordsPosted February 18, 2020
By Jonathan A. Karon
As a personal injury attorney, I spend a large portion of my time requesting and reviewing my clients’ medical records. In every personal injury trial, the plaintiff’s medical records are important evidence. Until the past ten years, most medical records were created by hand. This created problems when doctors or nurses had illegible handwriting. Commonly used medical abbreviations were also a source of confusion. Although armed with a medical dictionary and dictionary of medical abbreviations, I could usually decipher the records, explaining them clearly to the jury was a challenge.
Given all those problems, I initially welcomed the transition to electronic medical records. Now all the information would be clearly typed, everyone could agree what it said, and, although I still might need a medical dictionary (or at least access to google) to understand a few terms, everything would be easier. Except that’s not what happened. Instead, electronic medical records became voluminous, incomprehensible, messes of confusing, repetitive entries.
Under the old system, doctors and nurses would handwrite “progress notes” during hospital admissions and “office notes” during out-patient treatment. These would relate the important observations occurring at that time, such as pertinent history and physical findings and diagnoses. Assuming you could decipher the handwriting and abbreviations, you usually had a clear picture of what was going on at that time. Because they were handwritten, you usually did not have a lot of unnecessary information.
Electronic medical records, in contrast, can be a wealth of unnecessary, repetitive information. Doctors frequently “cut and paste” entries from their prior office visits and diagnoses from years prior, which are then carried forward, with no clear indication whether the patient is still suffering from this condition or if it represents a problem which was treated and resolved years ago. This can make it difficult for a subsequent doctor to interpret the record. Sometimes even the physician who created the note has to look carefully at it to decipher what took place during a particular visit. Even worse, if an error is made regarding a patient’s medical history, it continues to be carried forward as part of the patient’s medical history in the record of each successive visit.
Moreover, electronic medical records frequently contain pages and pages of the same entries repeated for each successive visit. Trying to actually find the unique office notes for a patient’s treatment can sometimes feel like looking for a needle in haystack. I recently received hundreds of pages of medical records from a hospital in response to a request for my client’s out-patient treatment records. In fact, there were only about fifteen pages of actual office notes. The rest were irrelevant, duplicative computer generated forms.
Apparently, doctors don’t like them either. In an article in the Boston Sunday Globe, updated on February 5, 2020, Dr. Samuel Shem (the pen name of physician Stephen Bergman, author of House of God and other novels about doctors) cited a report in the American Journal of Medicine that “the one thing in medicine that seemed to correlate with the rise of [doctor] burnout was the electronic medical record.”
Dr. Shem offered an explanation for why electronic medical records became a problem. “[I]f [electronic medical records] had only been for medical data and transmission of data, all would be well. But the private insurance industry somehow got into them, and linked every bit of medical data to a cash payment. Now, the data part has been consumed by the payment part. These screens have become, for the most part, billing machines, battlegrounds between health care organizations and insurers.”
So, not only do they make my job more difficult, but more importantly, they make your doctor’s job more difficult. That’s why I hate electronic medical records.
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