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Are EMRs Killing the Clinical Narrative?

Scott Mace, for HealthLeaders Media, March 20, 2012

"I have a feeling 'Don't recertify patient to fly without this procedure' is not a check box that is easy to put into this medical record," Resnik says.

Symptoms also change over time, and EMRs may not be nearly as good as a narrative when expressing this.

On top of all these concerns, a generation of older clinicians who are used to simply narrating their records creates a recipe for a mass exodus of personnel on top of growing doctor shortages.

Resnik worries that with the current stampede to meaningful use, all these considerations are being ignored.

As somewhat of a salvation, work continues on natural language processing. Resnik, who consults in this field, notes that machines are making strikes in learning to read, parse, and code narratives, partly because of the recent move to "big data" and advances in machine learning such as IBM's Watson project.

In other fields, including marketing and advertising, big data—the sophisticated analysis of very large data sets—is a big deal. Healthcare tech seems to be late to the game. Too many of today's EMR solutions seem to be based on the old-style client/server technology of the 1990s.

In Resnik's opinion, doctors shouldn't be checking boxes while they're trying to do a narrative. He says there are ways to "engineer the ergonomics" of the system. He, and I, think it's time we do.


Scott Mace is senior technology editor at HealthLeaders Media.
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11 comments on "Are EMRs Killing the Clinical Narrative?"


S. Silverstein MD (3/28/2012 at 12:21 PM)
I remind that the goal of the medical informatics pioneers was lexical and semantic clarity, not ambiguation. They intended that computational linguistics-based analysis of free text would accomplish this. The commercial sector, however, saw fit to ignore this work and try to make EHR's a "medicine by template" affair - much faster to market, and much more profitable. Imagine lawyers trying to practice "template law." Their briefs would be impaired beyond use. I note that it is possible to prevent EMR's from producing "legible gibberish." An example is here: http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story

Beth Friedman (3/26/2012 at 2:10 PM)
Yes. Anyone who uses the doctors narrative reports day in and day out, such as coders, CDI, researchers, and auditors, is aware of this problem. EMRs make cutting and pasting, shortcuts and over-documenting way too easy. While I understand that physician documentation should be there for patient care - not necessarily all the various downstream functions - that's not the reality in the U.S. Physician documentation is the basis for so many downstream functions and reports. The onus is really on the physicians and the vendors to make the process of documenting a by-product of care. Until then, it will be a difficult balancing act between ease of use for MDs and enough information for downstream functions and quality reporting.

Steve Wilkins (3/22/2012 at 6:16 PM)
Scott, Add to the issues you articulated so well in your post the issue of EMRs and physician de-skilling. As physicians switch over to filling out the EMR, they are not documenting so much of what they used to capture in their notes before. Check out a piece on physician de-skilling at http://wp.me/pGXmn-t4 Steve Wilkins www.healthecommunications.wordpress.com