EMR Doctor’s Blog: When does efficiency in documentation become misguided and counterproductive?

We have all seen medical records from an emergency department (my apologies to the blissful ignorant out there — you don’t want to know if you don’t already). Much like sausage, they come out pretty much all ground up, full of information that at first glance can be difficult to figure out. If you find yourself asking questions such as, “Where is the part about why the patient came in and what the doctor thought about their case?” then you just might have one of these notes. They’re actually one of my favorite types of “old medical records” to sift through for the purposes of “reviewing and summarizing”. This is because when you’re dealing with gobbledygook, well, there’s not much to summarize. It’s easy to flip through forty or fifty pages in no time and say that you have honestly reviewed and summarized the old records, which are full of near meaninglessness that doesn’t impact my decisions in the patient’s care much, if at all.

The ER notes (and many primary doctor visit notes nowadays) result from having programmers who don’t appear to understand the appeal of a well-written note in facilitating basic communication. Computer programmers who get their hands on the list of required information that must be put into a note to pass by insurance standards don’t always design good products. Unfortunately, this really only highlights the insanity of criteria for medical documentation to gain the golden eggs of insurance company reimbursements for providing medical services. I’ll save those crazy criteria for some other day. Nonetheless, the tax man and the gobbledygook cometh. If only they had the guidance of a practicing physician in the design process!

Unfortunately, as the gold rush for economic stimulus dollars ramps up, poorly designed systems will most assuredly continue to be thrown onto the market. I recommend to anyone considering incorporating an EHR system into your practice that you actually consider and request to review a sample of the output format. If it looks like something that would embarrass you to show your former mentors from the residency or fellowship program in which you trained, then I would posit that this is probably not fit for medical documentation. If no one wants to read what you wrote, then is it really worth doing? And please don’t be fooled into thinking that spending more money is the key to getting a better product. Ask the EHR vendors to put their money where their mouth is.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

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4 Comments

  • “Ask the EHR vendors to put their money where their mouth is”
    I could not agree more with this comment and with the rest of your post. The whole point of this is to save lives and someone along the way lost sight of that. The system should be FREE, secure, easy to install and CERTIFIED. They should also be flexible, allowing the doctor to create templates that are easily reproduced, allow the user to use voice recognition tools, Dragon speak, or enable hand writting recognition using a tablet PC.

    My Dad almost died as a result of a simple error in record keeping that meant a doubling of his medication. So one system to look at that has been proven by its founder to reduce errors and resulting fatalities is MitochonSystems. http://mitochonsystems.com

    It is all of the above and more and I think the following comment from their CEO CHris Riley sums it up.

    “OUR ETHOS IS THAT PHYSICIANS SHOULD NOT PAY FOR HEALTH IT, THEY CANNOT AFFORD IT AND HIGH COSTS PREVENTS ADOPTION AND THE BENEFITS IT CAN HAVE

    WE USE AN ALTERNATE REVENUE MODEL, CLINICAL MESSAGING AND PHARMA ADVERTISING TO ALLOW OUR SERVICE TO BE DELIVERED FREE”

    Jim Davidson

  • It is interesting to see that many of these rants against EHR documentation completely absolve the physician creating the note. Most have a full kit of documentation tools that are either not used or misused resulting in the garbled verbiage. Get a good system, make sure it has a variety of tools for documentation and learn to use them.

    If that doesn’t work use voice recognition.

    Really, there is no excuse for poor documentation any longer.

  • Tim, your point “Get a good system” is the real challenge because there are a lot of garbage systems out there. I agree that it is the doctors responsibility to make sure a good system is selected. Unless you work at a hospital or large group practice and thus cannot choose for yourself.

  • Dr. West – good point and we should certainly add that the bizarre, counterproductive E&M coding regulations have driven EHR design entirely towards tortured prose for the purpose of meeting stupid payment rules instead of allowing it to focus on communicating a plan of care. This is a tragedy of Epic proportions given the billions of dollars of investment in EHR.

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