Saturday, June 12, 2010

Electronic Health Records – An Obsessive Compulsive Technological Disorder in Which More is Less

There’s an electronic obsessive compulsive sickness out there.

Its symptoms are: the more information you provide, the more prolix, the more filled with boilerplate, the more templates, the more details, the more compulsive clutter, the more “documented,” the more “perfect” the electronic health record becomes, and higher its levels of reimbursement.

Presumably, if EHRs contained every piece of personal health data from cradle to grave, these electronic-information carriers would transform medicine for the better.

Unfortunately, more can be less.

This obsessive-compulsive preoccupation with documentation borders on the non-commonsensical. A specialist told me he routinely receives 6 to 10 page EHR reports from primary care doctors containing everything he doesn’t need to know and nothing of what he wants to know, containing a pithy note saying why the patient was referred, expressed in plain English.

Paul Sax, MD, clinical director for infectious diseases at Brigham and Woman’s Hospital, says specialists writing consult notes, are guilty of the same electronic longevity. In a contribution to a recent, blog, Sax wrote,

“Electronic medical records have, if anything, made matters even worse for the detail-obsessed. The ability to cut and paste endless reams of data into a note is irresistible to most ID docs.

It leads to a bizarre paradox where the more information in the note, often the less useful it is — a phenomenon expertly dissected over here on Says guest writer Jaan Sidorov:

‘[A doctor] had received a copy of a lengthy consultant-physician’s documentation involving one of his patients and was astonished by the blob of past data, prior notes, test results, excerpts, quotes, interpretations and correspondence that had been replicated word-for-word in the course of “seeing” his patient. The terse portions describing what the patient actually said, what the consulting doctor actually examined and what the diagnosis and plan were were inconspicuously buried toward the end of the EHR document.

And you know what’s most maddening? Under the current “guidelines” for coding and billing, there are true incentives — both financial and regulatory — to write this kind of text-heavy note, one heavily infused with templates and boilerplate language. The more complexity the better!’

“Here’s a proposal: the goal of a consult note should be concise documentation of what you think, and why, then what you’re recommending, and why.”

To sum up,

EHR proponents proclaim, “Cut and paste"!
Never let data lie fallow and go to waste!
If there’s a template, paste it!
If there’s boilerplate, paste it!
Never never, never, let anything be erased!

EHR proponents seek chart perfection,
They seek full and utter documentation.
Obsessively, they say leave no stone unturned.
Compulsively, they say data must be re-churned,
To add to their data and coin collection.

They say more is better for the bottom line,
More and more data suits them just fine.
Force physicians to click and send it.
Sure, others may not be able to read it,
But what’s good for computers is good for mankind.

But I say EHRs should have a place for brevity,
for a speech recognition succinct documentary.
In short, a place to be terse,
for nothing is worse,
than electronic longevity.


kevinh76 said...

Regarding the primary care to specialist EHR nonsensical communication - and visa versa!

Gary M. Levin said...

It is interesting how the motivation for going into medicine or a specialty was NOT compensation ten or twenty years ago. Most aspiring physicians then chose their interest or special abilities to chose a specialty.