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At a recent appointment with my ophthalmologist, the topic turned to electronic medical records. Turns out my physician was familiar with my journalistic efforts--maybe he recognized me by my picture (which suggests my glasses need updating). He practices in a large faculty group that is affiliated with an academic medical center. The physician group began its EMR journey several years ago and has been deploying new software on a  specialty-by-specialty basis.

Although brief, our conversation quickly focused on one of the key obstacles facing physicians as they convert to EMRs. Medicine is so highly specialized that having a one-size-fits-all documentation template is all but impossible. As my doctor explained, ophthalmologists like to document conditions using schematic diagrams of the eye. They also track a variety of measures on eye performance that would be all but alien to other physicians. Thus, his department had not rushed to deploy the EMR, as the department was waiting for its modules to be updated.

My physician is no stranger to technology. He has helped pioneer the use of lasers in corrective eye surgery, and the practice has built up a following for the high-end procedure. Maybe that explains why he volunteered to be the physician guinea pig for the department’s roll-out of the EMR. In the exam room, he showed me a flat-screen monitor, enthusiastically describing how having patient data available during the visit would beat having to rely on a dog-eared paper record.

When it comes to clinical documentation, physicians are not as averse to modern technology as they are sometimes reputed to be. They do, however, have legitimate concerns about how digital recordkeeping will mesh with their specialty. I have talked to many a multispecialty group practice that has made documentation flexibility the cornerstone of their EMR vendor search. They want to see some templates in action--or at least know that their software is pliable enough to fulfill their needs.

That can be a tall order. Just think about the respective worlds of, say, a pediatrician, an orthopedic surgeon, and a gastroenterologist. When they need new glasses, they all go to the eye doctor. But when they need an EMR, it’s another story.
—Gary Baldwin

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