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 Comments on this article:

An excellent article!  One thing that I have noticed as a primary care physician is that before the advent of electronic records and templates, I would get a nice one page letter from a consultant that told me everything that I needed to know about the patient I had referred.  Now I get a 5 page letter that says the same thing in a bottom line way, but I have to wade through 4 extra pages of “fluff” in order to get to the pertinent information.  Still, I am an advocate of electronic records WHEN used appropriately.

By Harry J Brown, MD on Aug 01, 2012 at 6:17pm

All of the “fluff” in an EMR note is due to the payors deciding how many review of system items and physical exam items need to be documented in order to get adequate reimbursement. The payors are the driving force behind the excessive chart documentation, and physicians need our lobbying bodies to fight back. I got as much info from a note stating “ROS: neg” as I do from the template driven review of systems. The verbage glut can actually make it harder to find what is important in a note. The primary purpose of a note should be to accurately record the encounter and to communicate to the next reader of the note - not to satisfy an insurance company.

By William Laurence MD on Aug 02, 2012 at 11:44pm

I appreciate the time and effort that went into the article by the author.  I would like to make a few points regarding the use of the EMR.  I am a Pulmonary and Critical Care locums MD traveling the USA and working in many different hospital systems.  The issue I think here really is how does the patient care change with the EMR.  Most of my time is spent in the hospital setting.  I do some clinic.  I would argue that the data are not complete on how this affects patient safety and improves care.  YES it is helpful when used well.  I still find “chart lore” in the electronic medical record despite the efforts to make it more accurate.  Automatic population of fields, as the writer points out, may end up causing more problems.  Also if the system requires too many prompts to be selected via the mouse, the patient with a BMI of 55 may have on paper a flat abdominal exam.  We all can read through the mistake as health care providers, but in a court of law it becomes a long list of inaccurate data that we have signed our name to.  This makes the chart appear less accurate.  I do agree that it is very nice to have the ability to pull up information such as labs and read notes that you can actually read.  I would just caution that we are not immune to the law of unintended outcomes.  We must always be realize for our patients that the information may not be as accurate as one assumes.  This is very evident in notes I have read that are cut and pasted from a previous note…Sometimes my patient was extubated “yesterday” for eight days in a row. 

I must admit that no system is perfect. I am not too excited about going back to complete paper charts, but I simply wanted to comment and point out that the EMR creates a whole new set of potential medical errors.  We have yet to see the full impact of how this affects patient safety, and at the end of the day, the patient care is most important.

By Craig Rosebrock MD on Aug 28, 2012 at 5:19pm

Excellent Comment I was not aware of the AHED grant program
Could I have an email address for information

By Ancilla Tragler on Aug 28, 2012 at 11:23pm

Excellent article. It impresses me as a family physician how many cardiology notes document such a thorough abdominal and GYN exam and the notes are exactly the same except for the interim paragraph and plan. One group was penalized by Medicare for using canned templates repetatively.

By Edward Plyler, MD on Sep 03, 2012 at 7:18pm