With $17 billion set aside in the economic stimulus package for electronic health records and the Obama administration's stated goal of digitizing the country's medical records in five years, a lot of people have been wondering: Can we do it? Will we be able to digitize the nations health records and put this kind of healthcare technology in the offices of every healthcare provider, big and small, across the country?Few people though have asked perhaps an even more important question: Should we do it? Is nationwide EHR adoption a good idea? In a New York Times editorial published earlier this month, Anne Armstrong-Coben, an assistant clinical professor of pediatrics at Columbia, wondered just that.
From NYTimes.com: --- Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room -- making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is "in pain," and to restrain my potty mouth when the computer malfunctions or the screen locks up. I advise teenagers to limit computer time as I sit before one myself for hours each day until my own eyes twitch and my neck starts to spasm.
In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer's font, important points often get lost. I have half-joked with residents that they could type "child has no head" in the middle of a computer record -- and it might be missed. ---
It seems to me that Armstrong-Coben's issue isn't with technology in the doctor's office so much as it with the quality and design of that technology. Surely, we can a.) develop hardware and software that is flexible enough that a doctor isn't tied down to a linear progression of questions and b.) leverage tablet PCs and other smaller form factor computing options to improve usability.
In many ways, solutions that meet those criteria already exist. The key will be in getting doctors to do their due diligence in selecting a system that's right for them, as opposed to selecting the system that's right in front of them.
So, to answer that "should we?" question I posed at the beginning of this post, yes we should digitize the health record keeping system. It's just that, we should keep in mind increased technology is not the ultimate goal, increased functionality is.
From the NYTimes: --- So before we embrace the inevitable, there should be more discussion and study of electronic records, or at a minimum acknowledgment of the downside. A hybrid may be the answer - perhaps electronic records should be kept only on tablet computers, allowing the provider to write or draw, and to face the patient.
The personal relationships we build in primary care must remain a priority, because they are integral to improved health outcomes. Let us not forget this as we put keyboards and screens within the intimate walls of our medical homes. ---