The Electronic Medical Record: Optimizing Human not Computer Capabilities

Abstract

The widespread adoption of computerized medical records provides medical administrators and payers the means to promote more standardized and thorough medical records by insuring clinicians complete mandatory screens, history and physical templates, and formatted treatment plans. But there is a dearth of evidence that such measures, whether computerized or not, improve clinical outcomes and reason to suspect that they may impede care. While these measures maximize the computer's capabilities they are insensitive to human capabilities. A series of 'check-offs', 'fill-ins' and 'drop-downs' might facilitate quality assurance activities, but such standardized measures can interfere with the clinicians' processing of information into narrative structures that are necessary for memory and decision making. Computerization does not necessitate this standardization. The adoption of an electronic medical record could provide the opportunity to move beyond standardized measures that were developed to oversee written records and instead harness the computers' capabilities to promote the unique, specific, and narrative quality of the clinical encounter.

Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS)

“…The RfE allows much richer understanding of what is 'going on' in the consultation, both of the perspective of the patient and of the process of diagnosis. 1,2,[7][8][9][10][11][12][13][14]40,41,44,[46][47][48][49][50][51][52][53]55 Nevertheless, this only occurs quite rarely within international primary care, and the diagnosis is often the only element of the encounter to be documented. 1,2,6,8,9 The fact that such data are often recorded on the basis of encounters and not episodes of care, 5 further complicates the interpretation of such data since the evolution of the problem over time is not captured and data accuracy consequently suffers.…”

“…These rubrics appear to greatly enhance the clinical reliability and relevance of patient documentation and play a major role in estimating probabilities for diagnoses in standard sex/age groups. [6][7][8][9]11,12 In principle, codes for diagnoses, symptoms and complaints from another coding system such as Read or Snomed could also be used to code RfEs. However, ICPC is a superior tool for this purpose, having been designed for primary care and for coding RfEs.…”

“…Forty-three articles which discussed the concept of the RfE and/or that collected or used RfE data were included in this review. Of these, 14 elaborated on the RfE concept, 11,[38][39][40][41][43][44][45][46][47][48][49][50][51] 29 used ICPC as a classification, 9,10,13,14,18,23,25,27,28,30,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 7 originated from or were closely related to the Transition Project, with which the two authors are closely associated. 13,23,27,41,44,50,…”

The era of “e”: The use of new technologies in advance care planning

“…Further, it is logistically complex and expensive to provide individuals and institutions the technical support necessary to both facilitate ACP and to prevent paralyzing system failures. There is also ample evidence that high tech solutions are sometimes more burdensome than liberating (Gajic, Herasevich, & Hubmayr, 2010; Lau et al, 2012), and that careful design is needed to prevent technology from becoming overwhelming and anxiety-provoking (Kadry, Sanderson, & Macario, 2010; Luchins, 2010; Rebitzer, Rege, & Shepard, 2008). …”

Health and Clinical Management – From the Pen and Paper to the Digital Era

“…As information and communication technologies (ICT) can offer solutions in storing, retrieving and processing data and communication technology can provide solutions in the transfer of information, it has stepped into healthcare a few decades ago [2]. Still, one should not be surprised that it did not yet deliver solutions to all challenges, that not all computing interventions have the desired positive effect [3], nor that sometimes it is perceived as a burden and gives healthcare professionals the feeling of serving ICT instead of ICT serving them [4]. But most will agree, or at least hope, that computers are for healthcare as indispensable as Google is for searches, and as practical as smartphones [5].…”