The Medical Record Moving Forward

With the HITECH Act, the role of the medical record is being further stretched to serve as data repository for quality reporting, clinical studies, public health surveillance and more. The problem is that many electronic medical records systems are replacing the narrative note with computer-generated notes that, while useful for creating a data repository, are far less useful for supporting patient care. 
 

Notes that are meant to be focused and selective have become voluminous and templated, distracting from the key cognitive work of providing care.  Such charts may satisfy the demands of third-party payers, but they are the product of a word processor, not of physicians’ thoughtful review and analysis.
Pamela Hartzband, MD & Jerome Groopman, MD
NEJM 17 Apr 2007 
 

One common complaint is that EMR generated notes contain page after page of boilerplated lists.  What was once a concise one page note becomes five pages of data without much information.  Click here to see an example of an actual patient note, first as produced by an EMR and then in narrative form.  Physicians bemoan that they now have to hunt for pertinent clinical information that was previously easy to find (described as an exercise in Where’s Waldo by the authors quoted above).
 

Physicians are being told that they have no alternative but to switch from narrative notes to templated notes in order to use an electronic medical record.  Not true!  The technology exists to allow physicians have both a narrative note and populate a repository of discrete data.  It’s just that most legacy EMR systems don’t use this technology, so it isn’t widely promoted.
 

What is this technology?  A combination of Google-type search capability, natural language processing, XML tagging, and something called “structured narrative notes”.