Electronic Medical Records: Electronic Health Records, Electronic Gibbersih, and Speech Recognition Story Telling

EMRs do not tell stories. They produce electronic gibberish.

Here are two stories, the first dictated by a doctor and recorded by speech recognition software, and the second generated by an EMR using structured clicks.

Note #1 (dictated with Dragon Medical) - "The patient is a 74-year-old female who presents with a complaint of fall, 74-year-old female presents with complaint of neck pain, headache. She states that she had mechanical fall at home where she tripped and fell downstairs, approximately 9 steps and landed on her back. She complained of shortness of breath right after the event.
She noted that she had pain in her left ankle and left knee. She is not sure whether she had loss of consciousness and the patient further complains of the pain in the right wrist."

Note #2 (produced using an EHR template) - "The occurrence was one hour prior to arrival. The course of pain is constant. Location of pain: Head leg. Location of bleeding: None. Location of laceration: None. The degree of headache is mild. The other degree of pain is moderate. The degree of bleeding is negative. Mitigating factor is negative. Immobilization no backboard in place and no cervical collar in place. Fall description tripped. Intoxication: No alcohol intoxication. Location accident occurred was home."

The first note contains subjects, verbs, sentences, and paragraphs. It tells a story. It is a narrative. To use the jargon of bureaucrats seeking to develop EHR software to place in every doctor’s office in the land, it is “meaningful.”

The second note is gibberish. It contains data bytes, incomplete sentences, sentences featuring the weak verb “is.” It does not give you a picture of the patient’s story or of the doctor’s interpretation of what occurred . It is gibberish, which I define as incoherent .unintelligible talk, chatter, and jargon.

When 17.000physicians were asked which note they would "consider more valuable in treating this patient," 97 percent said note #1, the one created from free-form physician dictation via speech recognition. In addition, HPI note #1 was selected as the preferred note for addressing each of the following clinical communication objectives:

• "Driving high quality caregiver-to-caregiver communication," selected by 98 percent.

• "Recording the patient encounter, care recommendation and treatment history to safeguard them and/or their practice from medical/legal liability," selected by 93 percent.

• "Getting physician thoughts into the note - ensuring the medical decision-making is captured," selected by 97 percent.

• "Representing the uniqueness of the patient encounter - ensuring all relevant, personal information is captured and lives in the patient's health record," selected by 97 percent.

• Future visits with the patient "for understanding and recalling the patient's history," selected by 98 percent.

• 98 percent said HPI note #1 was "more complete and can be easily understood by the patient or another caregiver."

The moral of this tale is that doctors want to record and read stories, rather than trying to interpret electronic messages limited to templated text and structured data.

Otherwise I predict a national program of installing EHRs in every doctor’s office will be an non- interoperable boondoogle, or perhaps I should say boongoogle, that will neither advance or improve care.

Source: “Study Shows 96 Percent of Doctors Concerned About Losing the Unique Patient Story with Transition to Electronic Health Records,” Enhanced Online News – Nuance Communications, Inc. (NASDAQ, NUAN), December 24, 2009