EHR Benefit – Legibility of Notes

I’ve hinted for a little while that I was going to start a series of posts talking about the various benefits of using an EHR. I think this is an important subject worth discussing in greater detail. I hope that this series of posts will also help us move past meaningful use of an EHR for the government EHR money and explore all the other reasons why healthcare should fully adopt an EHR.

Back when I first started blogging about EMR software (It was 2005, before the term EHR came to be), I made this list of EMR and EHR benefits over paper charts. I’ll be using that list as the starting point for this series of EHR Benefit posts. I love the first paragraph on that page (which I likely haven’t touched since 2005):

This list is just a starting point to list off all the possible benefits of having an EMR or EHR. Probably a poor one, but a start nonetheless. My plan is for this list to grow over time as I think of new benefits or as people suggest things I’ve most certainly missed. Also, I think that most people often focus too much on the financial benefits of an EMR and so hopefully this list will include financial and other benefits beyond the financial implications.

The list definitely did grow, but I guess I never got around to updating the intro paragraph. Although, I am pleased to see that even back in 2005 I was as interested in the non-financial benefits of EHR. Certainly the financial benefits of EHR are incredibly important, but far too many people don’t take into account the other non-financial benefits in their analysis of EHR benefits. It’s just too hard for many to try and compare or put a value on the non-financial benefits of EHR. We’ll try to point these benefits out just the same.

Now for the first EHR benefit on the list:

Legibility of Notes
I’m really glad to start with an EHR benefit that everyone can understand with little explanation. Poor medical handwriting has been a running challenge in healthcare for as long as we’ve been documenting patient visits. I did a quick search on Google for “write like a doctor” and it had about 321 million results. That’s quite pervasive.

I can’t think of anyone that would argue that healthcare doesn’t have a challenge reading physician’s handwriting. No doubt there are plenty of exceptions to this, but even those with beautiful handwriting still have to read other doctors’ handwriting from their own office or from other doctors’ notes that get sent to their office. It’s great to have the notes, but if you can’t read them then what’s the point.

While certainly illegible handwriting is a major problem in the office, it also extends outside the office as well. Think of all the times pharmacists have had to call a doctor to clarify the prescription a patient brought in. Even worse than that is the number of times the pharmacist misread a script because a doctor’s handwriting is illegible. This becomes a non-issue in an electronic world where the prescription is either printed or ePrescribed.

Of course, none of this is new territory. Every doctor understands these benefits better than I’ve explained here. However, far too often when we think about implementing an EHR, we forget about these simple and easy to understand benefits. How much time is saved in your clinic by being able to read the handwriting in the chart? How much time is saved in healthcare when referrals come in an easy to read, legible format? How much time and how many lives are saved by pharmacists getting the proper prescription to the patient? All of these are hard measures to quantify, but they are real, tangible benefits of an EHR.

I won’t mislead you into thinking the shift from paper charts to EHR solves all the legibility problems. Many template driven EHR software that creates a mass of mostly irrelevant data can be just as hard to decipher as the hieroglyphic handwriting of some doctors. However, I’ve seen a tidal wave of push back against these documentation approaches and I think we’re getting better. I think the shift to quality of care reimbursement versus procedure based reimbursement will help this to go away as well.

There are other things a clinic leaves behind with paper charts. I’ve heard many tell me how many times they looked at the handwriting to recognize who had documented something in a paper chart. Certainly that same info is available in an EHR, but you do lose the instant recognition of who charted what in the chart.

Despite not being able to put a nice dollar value on the Legibility of Notes, it’s certainly an EHR benefit that can’t be forgotten. It’s very easy to adopt an EHR and take this for granted.

About the author

John Lynn

John Lynn

John Lynn is the Founder of 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.

6 Comments

  • I think that the endless sea of fluff text produced by a lot of EHR’s is an interesting detriment to EHR notes that stands in stark contrast to the legibility of words on the page because it also impacts readability. On one hand you have beautifully legible writing, and yet on the other hand 90% of that writing is (mostly) unimportant.

  • Theoretically, the use of pre-configured notes OUGHT to make doctors notes in EHRs easier to follow AND analyze. Assuming, of course, that they are put together properly and actually reflect the patient’s condition and treatment. I’d like to think that a doctor puts together the notes during the PT visit, and then reviews them later in the day, corrects and releases them. And that any meds go through ePrescribe and are discussed with and confirmed with the patient, and confirmed as formulary or generic by the ePrescribe system.

    But then, to quote an old Broadway song, I’m a ‘cockeyed optimist’!

    Of course, there is more at stake then just bad handwriting and easy misinterpretation. There is also the idea that patients test results from internal and external testing are ‘connected’ to the patient’s visit, and that the doctor saw them as part of the visit. And that the notes AND lab results can readily be retrieved together in a meaningful way.

  • I forgot to mention something. I’ve seen the ‘file’ of someone I know, at a certain specialist. It is multiple inches thick of mostly unusable information on all sorts of different forms and papers. I try to cringe when the specialist in question tries to check his last few sets of notes; he almost always misses something important in that huge mass. He has very clearly missed trends in treatment results that I easily spotted from a spreadsheet charting exercise I did. He may be far more qualified to interpret them, but I’m the only one who put 2 years of data into a chartable format. Yet he’s the researcher, author of many papers, and Chief of his department at an area hospital. He is super smart, yet doesn’t seem to ‘see’ what he’s not able to see – in reality, I’m sure he does, he just has trouble dealing with that reality.

  • Hi John,

    Your 2005 list included using lab and radiology testing facility interfaces to eliminate paper by automatically returning results to the EHR. Seven years later, the good news is that efforts by ONC to create a national, open source interface standard for EHR ordering and LIS reporting of clinical lab test results have been underway since January 2011 and are now in the pilot/production deployment stage with eight leading EHR, LIS and HIE vendors.

    (See: http://wiki.siframework.org/file/view/Laboratory%20Implementation%2011-13-2012%20V1.1.pptx and http://wiki.siframework.org/Laboratory+Initiatives+Pilots)

    Ultimately, this end-to-end interoperability solution will help disrupt HIE 1.0 by commoditizing and speeding the process of implementing and maintaining millions of interfaces and will be extended to include imaging and all other types of testing facilities. What it won’t ever do by itself however, is to replace the flawed EHR user interfaces that have displayed incomplete, hard to read fragmented test results data to physicians since medical computer system development began at Mass General Hospital in Boston in the 1960s.

    What physicians and their PHR using patients have always needed is a simple, intuitive standard results reporting standard that can display all of the approximately 7,500 available tests as complete, clinically integrated and actionable information.

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