EMR=CloneWars? - Hidden Dangers to Patient Care

CRMbuyer is reporting on the benefits of using voice recognition for EMR’s in medicine and presents a series of case studies from the ER.  There is a danger here in EMR’s I have not seen reported that voice recognition may help with  - but first some of their stats on adoption rates in the ER

A 2006 Healthcare Information Management and Systems Society survey found that 65 percent of chief information officers planned to get it by 2008. It’s being touted as a natural add-on to the electronic medical record, since doctors are used to recording their notes, says Harry Rhodes, director of practice leadership for the American Health Information Management Association.

They list all the usual benefits, speed, digital readability, access, yada yadda yada.  The obvious danger is misrecognitions since 2% error rates are not insiginifcant in large volume medical records.

But What is the hidden danger of EMRs docinthemachine you ask?  It is the inadvertant cloning of patients. 

Let me explain.  If you are an ER doc an EMR is fine.  Patient comes in with one line chief complaint.  History of illness simple fact based.  Short and to the point.  But for detailed problems in the primary care and specialists’ office too much detail is getting lost in the EMR’s.  That is because inmost cases docs are using template driven systems where they click off prepopopulated answers to questions or even touch screen menu choices.  This is done to speed up data entry when there is no voice recognition.  Most docs do not type well or when they do enter minimal info. 

I am a fertility specialist.  My practice Gold Coast IVF in New York has a set process we use to completely assess a patients’ past history and treatments and to really get to the nuances this requires quite a bit of narrative of question and answer info.  When I am done I have an individualized picture of that patient that is totally unique from other patients due to the details.  I know what her problem is and why and how she differs from others with the same diagnosis.  Furthermore, during her treatment I can go back to the record and reassess all this wealth of information.  What I see constantly when I receive EMR records from other practices (where the patient was first treated elsewhere and the treatments were not successful so they are now coming to me) is that the patients look identical.  That is - I can see histories populated from checklists and quick electronic choices.  Instead of all the details of a past treatment cycle it will list drug dose and failure with no detail of WHY it did not work.  The diseases all look the same.  There is never any detail on the nuances and subtle aspects of that individual’s condition.  So when a group uses these records and they review a treatment every single person with the same disease (the “patient clones”) end up looking identical and treated identically.  Cookie cutter assembly line medicine.

Perhaps voice recognition will allow the details to come back into medical EMR’s.  That or a lot more typing by the doc…