Electronic Medical Record Is Wrong

I’m a big believer that language, under certain conditions, can heavily influence how people think and what they do. I think one of the problems with electronic medical record adoption is the phrase itself.

Now, EMR isn’t my specialty – I just know there’s much more to the engineering, user-interfacing, legal, process design and other considerations than meets the surface.

But as the power of technologies expand while their costs contract, it may be time to re-think the whole premise of electronic medical records.

So let’s start with a simple question: Why have them? A few answers:

  • Capture data
  • Use data
  • Share data
  • Protect data
  • Audit data
  • Monitor compliance
  • Use in legal discovery
  • Care for patients
  • Care for patients
  • Care for patients
  • Care for patients
  • Care for patients
  • Care for patients

No, the duplicates of Care for Patients are not errors.

Documentation is a critical component of patient care. Really – it is! It shouldn’t be about protecting professional licenses and about indemnification (it is now, a sad reality of our times).

The true purpose of documentation is ultimately to help providers create a curated stream of relevant information for guiding caregiving decisions.

There are ancillary benefits – sharing data with patients who want access. More and more, patients not only want easy access to their health information but also the ability to share it with whomever they wish to share.

There are variations on documentation: Personal Healthcare Records versus Medical Records. Ultimately, those distinctions rest upon the user’s perspective. Clearly, patients have different needs from providers. But each needs to work with the other – and that’s where our conception of “electronic medical records” needs rethinking.

So maybe we need to un-stick ourselves from the “recording” part and get back to the “people we serve” part. Maybe we just need to ditch some of the language and freshen our eyes:

Ditch electronic: it’s electronic – big deal! It’ supposed to be electronic these days. The word electronic is being used as if we were writing a 1950s commercial with a fetish on all things electric. “Look kids, it’s an electronic book from outer space!”

Ditch medical – it’s all about patient care; the medical part is just one context to place around captured data.

Ditch record – it’s all about care. The goal of recording data isn’t to have a record. To emphasize an earlier point: recording’s purpose is to enable the use of information to make decisions.

We could use “Patient Care System”, which gets closer to what is needed, but even that sounds feigned – like a desperate vendor’s branding tactic to provide an “Enterprise-wide solution for clients”.

But we know how that works out: a half-brained product, developed without the help (or enthusiastic support) of key end-users (nurses, physicians, administrators, patients), bought-into by leadership that doesn’t have a holistic understanding of systems and processes, and implemented using snappy-named methodologies like Nine-Alpha.

(Maybe Healthcare is in a 1952 sci fi B-movie: Invasion of the Electronic Medical Record from Planet Six Sigma.)

No, the reality of EMR (and PHRs and all the other Rs in healthcare) is this: it’s almost a hopeless nightmare of vision, planning, funding and execution.

When facing the prospect of gigantic investments of financial, time and other resources, the wise thing to do is ask: Is this enough? Will this do it? Is there a larger and related set of problems which this one problem belongs to? If so, what might that solution look like?

Electronic Medical Record is wrong. It’s sending us down the wrong path. It’s taking us away from patient care and into the illusion of being accurate and safe and useful. It may be all three – but we need more than those for remarkable healthcare.

We’re not going to have adequate EMR solutions for a very long time – the fact that it’s 2011 and we’re still struggling with ‘electronic’ anything in healthcare should tell us something.

Let’s face it: our generation is paying the price for Healthcare’s sloth these last fifty years. That price is going to explode in the coming years. Oh well. Hopefully we’ll learn.

Time to do what’s right: teach the next generation of doctors and nurses and engineers and user experience designers about the importance of building systems that work around people, not things.

@PhilBaumann – @HealthIsSocial – Newsletter



0 Replies to “Electronic Medical Record Is Wrong”

  1. Loving the duplication, the ditching, but perhaps most of all the karate-chop to the windpipe of the Six Sigma MBA Ninjas.

    Those ’80s throwbacks make Ed Wood’s ouevre look beyond classy.

    As you conclude, hopefully we’ll learn and yes, it is indeed time for us all to do what is right. #socialgood

  2. Thanks for this post Phil.

    How easy is to forget that the ultimate purpose is patient care…. but once we are clear on the purpose I think health care will actually improve.

    Like you and Andrew said, it is time to rethink our actions and do what´s right.

Leave a Reply

Your email address will not be published. Required fields are marked *