In the August 1st issue of the Journal of the American Medical Association, Robert E. Hirschtick, MD, wrote an article entitled “John Lennon’s Elbow.” In the article, Dr. Hirschtick writes about how the quality of progress notes created within EMRs during patients’ hospital stays has consistently declined as these notes have become longer and longer from carry-forward and copy/paste usage. Progress notes have lost most of their value in updating other providers about the current status of the patient, and no one seems overly concerned about this.
The trend described in this article, in my opinion, seems to be driven by the issue that EMRs and their rigid patient workflows are forcing physicians away from one of Einstein’s principal tenets: “Everything should be made as simple as possible, but not simpler.” There seems to be more and more crammed into the physicians’ action of documenting on patients, which forces more administrative burden on physicians. As physicians are under pressure to see more patients, they are faced with the adoption curve of using EMRs tools and templates that aren’t always the best tool for the job. Physicians have told me that EMR templates are becoming more complex and onerous, whereas they were pitched as being more efficient. The consequence of this is the loss of the quality and brevity which, handwriting legibility aside, was the value of a paper chart.
I think this comes back to the issue of how best to combine human activities with the tools and technologies of the digital age. Technology, and EMRs in particular, walk a narrow path that can lead to great gains in efficiency and quality but is also an easy misstep away from leading to complexity and wastefulness, such as bloated progress notes that no one reads anymore.
If developers of tools and technology for healthcare providers and organizations don’t take the ultimate needs of the end-user (especially physicians) in mind, wouldn’t it be ironic if, after millions are spent on EMR implementations, providers go back to communicating through hand-written Post-It notes because technology was never able to deliver on its potential?
Jeremy Zasowski is the New Solutions Marketing Manager of 3M’s Emerging Business Team.