"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.