EHRs: Works of Literature?

E-health records are an oft-debated technological advance, and the concept of medical charts as patient narrative is one such point of contention. Neil Versel, editor at Fierce Health IT <a href=http://www.fiercehealthit.com/story/cutting-and-pasting-modern-medical-illness-or-attempt-fix-old-malady/2010-04-26>asks</a> how medical records can best be used to communicate patient history while reducing errors.

Electronic health records are an oft-debated technological advance, and the concept of medical charts as patient narrative is one such point of contention. Neil Versel, editor at Fierce Health IT asks how medical records can best be used to communicate patient history while reducing errors.

Versel points to criticism that EHRs use the copy-and-paste function to merge all patient history, relevant or not, essentially relegating current information to pages and pages of useless data. In addition, goes the argument, the medical record as health narrative is dying with the increasing use of copy-and-paste. But there's a fine balance to be had between too much and too little when it comes to health history, and medical professionals aren't known for their literary prowess, he says:

Physicians generally are not professional writers. They often can't or don't take the time to proofread for anything other than medical accuracy. Plain English is not exactly a hallmark of medical records. Doctors do like to have lots of information available to make their decisions, but it has to be the right information. If their records are cluttered with extraneous notes, they risk making bad decisions, and medical liability comes into play.

So, he asks, what is the solution? If the goal of EHRs is to ease recordkeeping, reduce errors and move towards more efficient patient care, can we find a way to use technology without making the process more difficult?

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