1. In some versions of the EMR it is very easy to copy and paste. This leads to the creation of duplicate progress notes such as the following passages which were buried in a pair of nearly identical 500+ word notes:
03/09/2009 “Patient underwent tracheostomy yesterday. Is more comfortable.”
03/10/2009 “Patient underwent tracheostomy yesterday. Is more comfortable.”
2. The ability to copy and paste coupled with the ease of dictation results in voluminous notes. As you may know, coding (directly linked to reimbursement) for visits is based on the extent of the care given. “If it’s not documented, it didn’t happen,” goes the saying. But now we have the inverse. It is so easy to document that notes are easily puffed up to “document” extensive encounters with every patient.
3. Because they are so long, they are difficult to read and the black-on-white appearance of the words on so many screens causes the reader to skim over most of the note and go straight to the plan or recommendations.
4. For privacy reasons, most of these programs shut down if one does not touch the keyboard or mouse within a minute or two. This means if one gets a phone call or other distraction, one often has to log in again. Again for privacy reasons, passwords must be changed frequently. I am unaware of massive attempts by hackers to access medical records. Most of the time they really aren’t that interesting.
5. Nurses’ notes have become very easy to write thanks to pop-up windows. In addition, regulatory agencies have mandated “documentation” of multiple nursing interventions and screens (likelihood of falling, skin condition, pain assessment, nutrition, etc, etc). Not only is the nursing record unreadable due to its size, the zeal to document has taken the nurse away from the bedside. They are so busy documenting that they have no time for patient care.
6. This is analogous to the lament from patients that their doctor no longer talks to them but rather sits facing the computer monitor so he can document his comprehensive visit.
7. Reviewing a record for assessment of quality of care is almost impossible as it is no longer possible to “leaf through” a medical record. And if the record is printed, one gets a two-foot high pile of paper with every iota of information about the patient’s admission. And it’s all black text on white paper so important items cannot be distinguished from garbage.
Yes, I know I have omitted references to the good features of the EMR, (instant access—while sometimes cumbersome—to old records, legibility, etc). But it is my blog after all.