Are EMRs Killing the Clinical Narrative?

Scott Mace, March 20, 2012

Could your new electronic medical record system be missing vital information the old paper-based system captured?

Even the most seasoned technology champion has to stop and ask that question, if for no other reason than the new medical record looks very different than the old one. To put it in classroom terms, today's EMR is often multiple-choice, not essay.

But almost as long as there have been doctors, the preferred way for them to communicate has been through a narrative—a story.

EMRs may introduce gaps in that narrative, says Philip Resnik, professor of linguistics in the Institute for Advanced Computer Studies at the University of Maryland.

Since 1999, Resnik's been studying the limitations of entering clinical information into discrete fields and checkboxes in an EMR. At the recent South by Southwest conference, Resnik described the dilemma clinicians face: to embrace the EMR with all its limitations, or to push ahead for new technologies such as natural language processing that rarely see clinical use today.

Resnik illustrates the problem with a sample narrative of a woman complaining of shortness of breath. In a slide he highlights snippets that are easily entered into EMRs, such as symptoms and actions taken. But he also underscores much text that helps tell the story of the patient's encounter in the ER but doesn't readily map to fields in an EMR.

Scott Mace

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.


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