We noted on Monday that some providers seem reluctant to climb aboard the electronic health record (EHR) bandwagon while certain definitions and criteria are pending. Lest we left anyone with the impression that we think EHR technology is a clear-cut solution to all that ails health care, it seemed worthwhile making ourselves clear. In fact, we think there are a lot of good things to say about EHR, but that there are some cautionary notes worth thinking about.

Dr. Nic van Terheyden has shown, for example, some of the limitations of existing EHR compared to current medical records practices, especially the narrative that many doctors dictate and transcribe after seeing a patient. If EHR is limited to a “point-and-click template,” which van Terheyden argues against, much detail and nuance of the patient case could be lost. For examle, he points to medical records of King Henry the VIII, and shows what would have been lost had his case been logged on today's computers.

Van Terheyden writes:

While templates help drive standardization and can ease data analysis, without the narrative we risk losing important clinical data that is buried, as shown in an example found on the Medical Transcription Industry Association website. The same note captured using a typical EHR system balloons to five pages, burgeoned with excess and difficult-to-read content, but from the narrative shrinks to two concise, readily digestible pages. The challenge is how to integrate the narrative into the EHR so as to benefit from the numerous EHR advantages of digitization and rapid sharing of information.

These sorts of challenges fall not only to the IT experts designing EHR technology and the doctors using it, but also to the state and federal officials who are trying to build an interoperable nationwide system of EHR and other health IT. It is crucial that any federal standards of health IT have enough flexibility and room for improvement to allow the best aspects of old methods—not to mention as-yet-unforeseen techniques—to be incorporated over time. It would be a shame if, in the transition into the healthcare records of the future, we lose some of the basic info that we had 400 years ago.

Hat tip: Priming the Pump

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