EMR Perpetuates Misinformation

I have a number of doctor friends that I know from church, scouts (yes, I’m an assistant scoutmaster), or other local group. I must admit that generally our focus is whatever activity is at hand, but every once in a while they or I will bring up the topic of EMR.

These types of discussions are especially fascinating because they give a nice insight into a doctor’s perspective from someone who’s not inside the healthcare IT bubble. You know, that bubble where we all know the difference between meaningful use stage 1 and 2, ONC-ATCB and CCHIT, and a whole set of other acronyms. Certainly these doctors know some of these terms or have at least heard of some of these terms, but they definitely don’t know all the details. In fact, that’s what makes it so interesting to see what they know and what they don’t know.

I bring all of this up because I had a short discussion with one of the really smart doctor friends of mine. When I say smart I mean it from a clinical standpoint (he’s seen me a few times), but he’s also a very smart businessman as well. So, with this respect I’m always interested to hear his take on things.

This doctor has been a user of an EMR for quite a few years. He’s quite satisfied with his EMR and in our discussion he is planning to get the Medicaid EHR incentive money. After a short discussion he stopped and told me, “John, you know the thing I dislike most about an EMR?”

Then, he proceeded to tell me, “The thing I dislike most about an EMR is that it perpetuates misinformation.”

I’d certainly considered the topic before, but I thought it was an excellent description of this EMR challenge.

Part of this reminds me of a guest post done by Dr. West about Copy and Paste in EMR (He now blogs at Happy EMR Doctor). Copy and paste has the challenge of perpetuating misinformation too. Although, I think his comment is much deeper than just copy and paste.

There’s a challenge in most EMR software to take whatever was entered as complete fact. It’s not usually as easy as putting a line through it to correct something that was entered incorrectly. There’s no reimbursement for correcting or updating records even if it’s really essential to great patient care. As a commenter on the above copy and paste post said, “It is not the machine or process, it comes down to ethics, professionalism, and accountability.”

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • And what’s worse? The Myth…

    The ongoing and growing Myth that EMR saves money and improves care. Over long periods of time, EMR has the potential to reduce costs, and once they can get past the privacy concerns and develop a model for sharing information, there is the potential to improve care… but the last is a big *IF*.

    IF they can develop a manner to ensure all clinicians take notes in a common form, that all data is stored in common formats (allowing for EDI), and the ‘science of medical analytics’ grows at a rate comparable to business analytics. The toughest row to hoe will be getting clinicians to agree on a standard form of note taking- until drop-down menus and pick lists are established that will allow them to select a visit type, then use common terms while capturing condition notes, it will be worse than trying to read chick-scratch handwritten notes.

  • Larry,
    It’s not a myth that EMR saves money. I’ve seen a number of cases where EMR saves money. The myth could be that EMR categorically saves money. I’ve certainly seen cases where a clinic lost money during an EMR implementation too. So, the truth is that EMR can save money if done right, but can lose money if done poorly. Of course, in the long term we’ll have to see how that plays out.

    I agree that having a common form will be important. Although, I think it’s unlikely to happen and we’re going to see a bunch of companies come together around dealing with analyzing data that’s not in a common form.

  • > perpetuates misinformation

    I’ll try not to be high-horsey here, but: yes, yes, yes: ANY method of recording crappy, erroneous information will perpetuate MISinformation. Handwriting, computers, anything.

    In all my years of working with data in different industries I’ve seen only two solutions for this:

    1. Don’t capture anything, because it might be wrong

    2. DATA QUALITY! Be responsible about data quality! About the accuracy of what goes into the record!

    My debacle in 2009, moving my hospital’s data into Google Health, was due entirely to the presence of a boatload of crappy data in my hospital’s billing system. The interface reliably perpetuated (i.e. revealed!) the crap, and the world was shocked.

    Data quality. Data quality. Data quality. Quality at the source. Draw a line in the sand: “From this day forward we’ll be careful what we record, to be sure it’s accurate and legible.” Before that date, our records are uncertain. And fire or retrain anyone who can’t cope with the concept.

  • I have to agree with Dave. As a pathologist who is used to reviewing charts as an outsider, I can’t count the time a consultant would just copy, verbatim (prior to EMR), the medical history, ROS, etc. from the primary – when I knew there were blatant errors in it. The EMR just speed up that process of being sloppy. You know the old saying about garbage….

    As for the ‘evils of EMR’ broadcast by many physicians, I say just wait till your elderly mother has so many docs you can’t keep them straight, and not ONE has any information that the others have, nor do they care they don’t have it. And God forbid she should switch hospitals – they use me as the repository of all the informatin they should already have. C’mon guys, let’s clean this up – there’s really no excuse.

  • I think that’s really my point bev M.D. Not that there wasn’t misinformation before EMR, but that EMR software makes it insanely easy and fast to perpetuate that information. That’s what makes it more of a challenge than it was before.

    In fact, part of the reason I call this out is to hopefully encourage data quality in an EMR since if it’s done wrong it will last.

    I actually think the work you’re doing with PHR and empowered patients is a good motivator for data quality. Having patients see the data that’s entered because it gets sent to a PHR provides another motivation for whoever’s documenting to do it in an accurate manner.

  • I am a family physician who has used EMRs for the past 10 years. I have been using Centricity for the past 5 years. I agree with the above comments that it is extremely difficult to change erroneous information, and in fact, EMRs make it easier to create erroneous information (GARBAGE IN-GARBAGE OUT), due to information overload. There is too much information that goes into them, so it is easy to overlook the erroneous information.
    We need to overhaul the EMR paradigm, change the way that information is entered; the current method is too time-consuming for providers, and is too rigid for decision-making or to communicate the most essential information.
    I continue to be aghast at the lack of input that providers (physicians, PAs, NPs, nurses, MAs) have on the design of EMRs. All current EMRs are designed essentially the same, with the same design flaws.
    If anyone is aware of how physicians can become more involved in the design process, especially in designing a more provider-oriented EMR (better usability), I would be very interested in learning more.

    –Paul J. Davis MD (Auburn, Maine)

  • Paul,
    I think one of the major challenges of the EMR documentation paradigm is the billing requirements. That needs to be overhauled and we’d see much better documentation.

    I’ve heard comments like yours so many times about lack of provider input in the design of the EMR. However, when you look at most EMR vendors, I can tell you that they’ve had massive doctor input. Every one of them has had doctors working during the design. So, doctors being involved isn’t the right solution either. It takes the right doctors too. Although, the biggest challenge there is really that no 2 doctors practice medicine a like.

    I’m sure that most reasonably sized EMR companies would welcome your feedback and participation. You could also go to a open source EMR like OpenEMR and have all the voice you want.

  • John,
    I agree that the billing paradigm needs to be changed, so that documentation is an end-result, rather than the goal. If billing and documentation could be better designed to reflect a practitioner’s diagnostic thought process, and be able to be more adaptable for documenting objective findings, I think that we would find better end-user satisfaction with EMRs and less cookie-cutter button-pushing, which invariably promotes error generation.

    –Paul

  • Paul,
    Well said.

    < begin sarcasm font >Although you’re focusing too much on a patient and provider focused documentation< / end sarcasm font >

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