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Reader Comments on: Clinicians Must Reinvent the Medical Record to Stimulate the Adoption of Electronic Medical Records See reader comments on this article and provide your own.
Readers are encouraged to respond to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net
To the Editor:
I totally dislike it that one of my doctors uses EMRs.[1] I find it very annoying when his assistant puts me on “hold” while she finds something on the screen, or when she has to type in something. Then the doctor comes in and it is very much the same scenario. This is in comparison to my other doctor, who uses the “old-fashioned” method of writing his own notes while paying good attention to what I'm saying without breaking the stride of conversation. Before I moved, my doctor always took notes and after the exam was over he'd talk into a recorder from which a report was typed. So, in this case, one person listened, jotted notes, and spoke; another typed. In the former, two typed, had difficulty listening, and the patient (me) was very frustrated. There has to be a much better way than having computers in the exam room!
Many patients and providers lament that the introduction of information technology can disrupt workflow and interfere with the doctor-patient dialog. Nevertheless, there are opportunities for both parties to capitalize upon electronic health records to improve the quality of the clinic visit. The patient should recognize that immediate access to more robust health information and decision support can improve medical decision making and provider adherence to best practice behaviors. Many health records provide summary reports and print capabilities. Hence, patients might request reports of medication lists, forthcoming appointments, or preventative health logs before leaving clinic. Likewise, providers can use information technology to engage patients as collaborative partners in their healthcare. Many health records can plot laboratory data, display radiographic images, or show medication pictures. This type of multimedia information affords the provider the opportunity to educate and counsel patients in new ways.
To the Editor:
As a member of the research group that worked under the leadership of Dr. Lawrence Weed in the 1970's developing the Computerized Problem-Oriented Medical Information System (PROMIS), I view the current discussions about EHRs as well-intended yet often futile attempts to recreate the wheel.[1]
PROMIS, a federally-funded prototype, not only enabled the efficient generation of a problem-oriented medical record with history, physical exam, problem lists, laboratory results, and progress notes in electronic form, it also furnished up-to-date medical information and guidance in the course of providing care, as well as the ability to audit care-giver performance and conduct population studies and research on large numbers of patients.
PROMIS was way ahead of its time in the 1970s both philosophically and technologically. It had the potential to revolutionize medical education and training and patient care but unfortunately was turned down both by medicine and the government.
Now, over 35 years later, its pioneering achievements continue to remain hidden as another generation tries to cope with the continuing challenges of the EHR. My recommendation to those who are really serious about solving the EHR problem is to investigate the specifics of the PROMIS project and contact Dr. Lawrence Weed for his enduring wisdom on this most important issue.
Dr. Weed's pioneering efforts in health records have had an indelible impact upon the evolution of health information management. And many informatics experts would agree that his work with PROMIS, a computerized version of the problem-oriented record, helped define the evolution of electronic record systems. However, it should be noted that Dr. Weed also recognized the importance of an “interconnected network for information exchange,” arguing that healthcare informatics will only realize its potential to improve the standard of care when data are easily exchanged across a unified health information platform. Regional health information organizations, data standards, and technology breakthroughs are more likely to be cultivated in a collaborative environment than in provincial research silos. Already, the collective capabilities of massive online communities have produced such products as Wikipedia, Linux, and the Human Genome Project. Providers, technology specialists, and informaticists should strive to join these social networks in order to learn, teach, and spur innovation.
