A couple of days ago, one of our readers made an interesting comment on the ways in which he feels that EMRs are a painful distraction from the practice of medicine:
In the trenches, this stuff pulls us away from our patients, gobbles precious mindshare, and is sometimes downright dangerous. And it’s not just click counts that are the problem. Every unintuitive click or unnecessary checkbox steals something away. It might be the way a pain was described, or the look I was given as I left the room, or the 6th critical thing I am remembering in a long list of critical things. But once I am clicking away, it is gone, to the detriment of my patients.
My colleague, John, responded by asking the poster whether these problems are really unique to EMRs, or whether there are equivalent distractions that arise when physicians use paper charts. Not being a doctor myself, I can’t offer the final word on this subject, but it might be interesting to compare the two side by side.
Below, I’ve outlined what I see as some of the key head-to-head comparisons we should consider when comparing paper charting to EMRs. I’d love to know whether you agree with my conclusions, or have more to add.
Style of recording information
Paper: Within standard limits, allows for free-text entry of whatever data the doctor would like to see recorded
EMR: Doctors must work with checkboxes, at least to some degree, and can only enter free text in prescribed areas
Finding historical data
Paper: If a doctor wants to find historical information, he or she must flip through previous pages; if the previous caregivers were precise and wrote neatly this may be fine, but if they didn’t this could led to confusion or inaccuracy.
EMR: If indexed well, EMRs make easy to find historical information, and by definition there’s no problem with reading illegible handwriting.
Advantage: I see this as a toss-up. Paper systems are familiar and in their own way, efficient when searching patient histories. EMRs offer legible — and if the data schema makes sense, easy to find — historical data. This one’s a matter of taste to some degree.
Capturing physicians’ experience accurately
Paper: The poster’s comments suggest that using paper allows him to directly and effectively record his impressions of patients as he gathers them.
EMR: Many doctors, not just the one commenting above, see the process of adapting to EMR workflow as an intrusion which takes them off their game and deprives their observations of the accuracy and richness of paper records.
Advantage: Paper. From what I’ve seen so far, there’s a lot of truth to the complaint that EMRs force doctors into workflow patterns which distract them, prevent them from working on intuitions of the moment and force them through routines that add no real value.