Kicking and screaming providers in the brave new world of electronic medical records

I had an interesting phone call by a fellow endocrinologist this past week.  He is “not quite there yet” in deciding if a particular EHR system is right for him.  He says he is so much faster on paper and is planning on just having the office staff scan his handritten notes into the computer system once they are done.

Firstly, this just continues the problem that EHRs are partly designed to solve:  the pervasive problem of illegible office notes.  I can tell you that most of the old medical records I receive for new patients coming into my practice are fairly useless if handwritten.  Personally, I think legible writing should be a tested requirement at every level of becoming a healthcare provider: medical school entry, medical school graduation, residency entry and graduation, and bi-annual medical license renewals.

Secondly, my doctor friend probably has a surprise ahead of him, since I have seen the upcoming plans for later stages of meaningful use.  One specific measure is going to be the use of electronic notes, not scans of handwriting.  It will be interesting to see how this plays out upon implementation, as there are potentially a lot of provides out there who will try to use loopholes to maintain handwritten records as long as possible.  I personally type and/or dictate using Dragon Dictation for iPhone, which eliminates any need I might have for writing.


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.  He can be reached at doctorwestindc@gmail.com.

About the author

Dr. Michael West

Dr. Michael West

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 in 2009. He can be contacted at doctorwestindc@gmail.com.

6 Comments

  • Nice scanned image there. Looks totally readable to me. Oh wait….no.

    Too bad EMR will ruin a whole industry of people who are talented at reading the medical “hieroglyphs” that so many doctors create.

  • It can only ruin them if they convert over, but you are right in that it will become more and more difficult to find this stuff in a decade. I wonder if there would ever be a law mandating EMR adoption if one cannot produce legible handwritten notes. Maybe a scribe would be great here as an alternative to EMR for those who don’t want to learn a new skill.

  • When I first started practicing as a doctor we used 100% hand written paper records for day-to-day ward notes. Talking to the senior docs, they were categorical that they would never start hand-typing their records themselves. One doctor even refused to do dictation and would have his sectretary come on ward rounds to write notes for him.

    I think I’m one of the transitional generation – I’m at the stage now where it is actually much faster for me to type rather than write by hand. I’m currenly completing my MBA and quite often the exams require hand written answers and I find it quite difficult to adjust. Not only is typing more legible, you can also write more clearly, make corrections, re-phrase, etc. Not to mention copy-pasting, and so on.

    I’d be very suprised if there isn’t a generation of doctors graduating at the moment who would much prefer to type rather than write by hand.

  • Chris, I’m glad that we’re getting into new generations. Some of my older colleagues are starting to call me as they realize their practices are getting behind. You really have to adjust your mindset if you ask me. For older docs, I think they are used to having 5-star service and all they have to do is talk and scribble. I think accountability is about to bite back. I feel for them, but the laws of supply and demand are clearly moving medicine away from where it used to be, and not necessarily for the worse.

  • It sounds like this is an issue with the decision in EMR. Did the physician view various demos? Did he get to ‘test’ the software before purchasing it? The decision of which EMR to implement is such an important part. You must take your time with that portion….

  • Marcella, while Practice Fusion will allow you to test the software for free, most other pay-for systems can only be seen as a demo that is run by a vendor salesman. They don’t typically allow you to test drive their systems to my knowledge. I think allowing a real test drive for a month should be a requirement that the vendors should have to allow.

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