EMR implementation: the law of unintended consequences

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Specifically (and I’ll largely use Dr. Chen’s words, in order):

  • ‘difficulties replicating the narrative aspect of a patient’s illness and the constant interruptions from alerts and instant messaging. ‘
  • ‘Doctors often must consider several issues simultaneously when seeing a single patient’–potential diagnoses, treatments, patient history, adverse effects, drug interactions.  This ‘can push some doctors into what one EMR expert refers to as “cognitive overload.”
  • ‘most systems have been designed not with clinical needs in mind but to meet the demands of the fee-for-service payment system’
  • ‘While EMR can capture certain information like medication lists and test results with mind-boggling accuracy and efficiency, it often fails to relay the nuances of a patient’s illness course.’

She quotes Dr. C.T. Lin of the University of Colorado.  ‘Physicians think in stories. How can you possibly point and click your way through a patient’s 10-year history?’  To work around this, he is heading an effort to explore technologies like speech recognition to dictate patient histories, thus restoring narrative.  She recommends placing/tethering EMR screens/terminals to where they are easy to reach and the interaction is as unobtrusive and natural to the patient as possible, along with physician training on effective communication–and listening–in the presence of an EMR. 

And consider the effect of all that other data that will be cascading in from telehealth and telecare devices…how to integrate?