One Chart

Computers are handy tools. 

With all the discussion of Electronic Medical Records (EMR) or Electronic Health Records (EHR - which autocorrect tries to change to HER), I don’t understand all the enthusiasm without any mention of how the drawbacks will be addressed.

There are, of course, some benefits.  The idea isn’t just to make it easier for individual doctors to keep track of data.  The idea is to share data.   Data such as lab results, MRI and x-ray images, and what prescriptions a person has filled are all objective.  Read the numbers, view the images, confirm that medications are being purchased – these things can help patients by making it easier for doctors to do their jobs.

What about sharing other information?  For years doctors have made observations and written corresponding notes about those observations.  Sometimes, though, doctors are wrong.  Being wrong in one paper chart in a single location isn’t desirable, but it isn’t earth shattering.  The doctor eventually (one would hope) finds the right solution, the correction is documented, and all is well.  OR perhaps the patient goes somewhere else, a different physician finds the solution, and the previous (wrong) doctor is never seen again. Maybe it doesn’t matter if wrong information is locked in a file cabinet somewhere in a dusty basement.

It’s very different when erroneous information is documented and then shared with others.  Wrong observations by one person can be digitally transmitted to a multitude of others, and that misinformation can haunt a patient to the grave.

EMRs mean that patients need to know exactly what their doctors are writing, and make sure that no errors are allowed to stand so that future providers aren’t influenced by bad information.

About these ads

4 thoughts on “One Chart

  1. That’s an excellent observation, Socks. I’m all for EMRs — to a great degree, that’s what the VA medical system uses, and I’ve seen how useful it is for all of the various doctors I’ve been treated by to be able to pull up information about me instantly via their computers. But you’re right. Mistakes can and will, unfortunately, also be brought up instantly.

    Perhaps the answer will be that the patient must be allowed to approve/disapprove the info that goes into her records? Wow — I can see the bugabears that might cause, too. Huge ones. Hmmmm. I hope that the people in charge of making this all happen are also thinking as clearly about all this as you are …

    And by the way, love the new blog template. This is really nice, Socks. :)
    Also, how’s your shoulder? How’s the RA? Thinking of you …

    • I understand that doctors need a place to write private notes (reminders of things to check, suspicions, and so on). So long as private notes are private, visible only to the person who writes them, I’m okay with it if that’s what’s needed for people to do the best job possible. Its when things are available to others and might be shared that I think patients need to keep on top of things to make sure everything is accurate.

      Thank you. I was looking for red-white-and-blue for the Independence Day weekend and got sidetracked. Haven’t yet decided if I’ll keep this format or not. The shoulder is improving slowly, which is good because it means there’s one joint that doesn’t hurt. I’m hoping that it continues to get better and doesn’t do a 180 when the cortisone injection wears off.

  2. I think that if this universal EMR ever gets implemented this won’t be as much a problem as you suspect, warmsocks. It will be the same problem it is now in that we all tend to refer to past knowledge to guide us until it is proven incorrect. (It is a mental prejudice common to all human thinking that generally serves us well but sometimes blinds us to correct solutions.)

    But once such a system is up and running I think any doc that has ever used the Internet or stayed up to date on medical research shouldn’t have trouble navigating it. In the information age we have all gotten used to sorting through lots of info some of which we assume to be outdated, misleading, or flat out wrong. A doctors note is an impression at that moment in time. It is useful to have, but it isn’t infallible. Doctors of all people know that.

    I think the info age has proven that if you give people lots of data they are surprisingly good at picking out the useful stuff from the bullshit. The benefits of a universal EMR far outweigh this risk.

    • Hi Doctor D! Thanks for stopping by. Hope the move went well and you’re getting settled in your new location.

      If doctors view another doc’s notes and recognize that any of it could be wrong, and do their own assessment and make independent decisions, then there’s little problem. From multiple patient blogs, it doesn’t sound like that really happens. My own story: a guy decided that I was looking for drugs (my PCP was astonished at this assessment). Since he thought I was looking for drugs, he discounted my description of my pain and decided that FMS was a suitable diagnosis. Now, as I understand it, FMS means unexplained pain in all four quadrants, with a psych component, too.

      Now, admittedly I am a bit crazy – my family and friends have always said so – but it’s never before been a medical diagnosis. As for unexplained pain, well, there’s a difference between there not being a reason, and the person not bothering to look for the reason. I had longstanding bilateral trochanteric bursitis – there was an explanation for my hip pain. I also had bilateral tendonitis in my shoulders. Bursitis and tendonitis can cause muscle pain. There was a simple explanation for the muscle pain, and everything resolved with proper treatment.

      Yet he continued to stick with his erroneous FMS diagnosis. After a couple months he figured out that I wasn’t a drug seeker – only because he gave me a choice between a narcotic patch and a topical NSAID and I told him there was no way I’d ever take another prescription for pain medicine from him again; I’d rather deal with the pain than the side effects of narcotics.

      Fortunately, that doctor’s office does not use an EMR and I was able to walk away and find someone else who would listen to me instead of jumping to conclusions. I purposely did not provide records from the first doctor, however the new rheumy asked me to sign a records release so she could get that information. Instead I provided the minimum 1-page notes from my last appointment (that’s what she’d said she wanted). She’d thought she was done with the exam, but seeing the words “FMS-stable” on those old chart notes prompted her to do a quick tender-points exam. Of course it was negative because I don’t have fibro. I never did. The first guy was wrong. Still he clung to the erroneous FMS dx instead of admitting that he’d jumped to conclusions and missed the tendonitis in my shoulders.

      The law says that patients have the right to ask that their medical records be corrected. Having the right to ask does not guarantee that the correction will be made, or that a dispute will even be noted where someone looking at the wrong information can discover that there might be an error.

      Another time… no, maybe I’ll make that its own post. I understand that computers are useful tools for organizing and storing data. I’m not convinced that doctors, in looking at notes from other docs, will be more willing to consider that their colleagues might have missed something. Right now, patients have the option of going somewhere new and starting over. In the future, that is going to be difficult, if not impossible, to do. And there will be people who die because a wrong diagnosis gained momentum.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s