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letter
. 2015 Apr;5(2):93–94. doi: 10.1212/01.CPJ.0000464745.15088.b3

Special requirements for electronic medical records in neurology

Nitin K Sethi 1
PMCID: PMC5764440  PMID: 29443176

Unfortunately, I share neither the enthusiasm nor the optimism of McCarthy et al. about neurology-specific electronic medical records (EMRs).1 While some of the authors' suggestions, if incorporated, would certainly make my life easier and my clinical care more efficient, I am not convinced they would translate into better patient care. Much has been written about the pros and cons of EMRs. Whether we admit it or not, current EMRs are designed primarily to ensure appropriate documentation of diagnosis and treatment in order to be compliant with billing and coding regulations. While the current generation of EMRs certainly makes the lives of compliance officers and medical coders easier, it does so at the cost of a patient history that is populated from multiple clicks on symptoms and exams that often are not relevant to the presenting complaint. I prefer to type my history, examination findings, and assessment into the EMR in free text form. It makes more sense to me and hopefully to a colleague who may be covering for me. But typing a note in this format takes time, unless you can type at the speed of thought! Self-cloning (cloning of your notes) is a big no-no and I ran afoul of the almighty compliance officer. As it stands today, the EMR remains an undue burden for this neurology care provider.

Disclosures:

N. Sethi serves as Associate Editor for The Eastern Journal of Medicine.

References

Neurol Clin Pract. 2015 Apr;5(2):93–94.

Authors Respond:

Lucas H. McCarthy, MD, MS, Christopher A. Longhurst, MD, MS, Jin S. Hahn, MD: We thank Dr. Sethi for his comments concerning the difficulties many physicians face regarding the usability of many current EMRs.1 EMR usability is a major source of physician professional dissatisfaction, as reported in a large survey sponsored by the American Medical Association (AMA) in 2013.2 According to a related press release from the AMA, EMR systems in use today are “cumbersome to operate and are an important contributor to [physician] dissatisfaction.”3 With this in mind, the AMA recently called for an EMR design overhaul and provided a framework for prioritizing redesign for physician usability to improve physician satisfaction.4 We agree that usability is an important focus for the future of EMRs and is not an issue specific to neurologists. The neurology-specific recommendations that we described are in line with the efforts of the AMA and other organizations to improve the functionality of EMRs through improved specialty-specific data collection, communication, and interoperability. With the increasingly widespread use of EMRs, we see many opportunities for improvement and encourage physicians to be an active part of the optimization process.

University of Washington (LHM), Seattle; Stanford University (CAL, JSH), Palo Alto, CA; and Lucile Packard Children's Hospital (CAL, JSH), Palo Alto, CA.

Disclosures: L.H. McCarthy reports no disclosures. C.A. Longhurst serves as an Associate Editor for Applied Clinical Informatics, serves on the medical advisory board for Doximity, receives research support from Hewlett Packard, and owns stock/stock options in Doximity. J.S. Hahn reports no disclosures.

Articles from Neurology: Clinical Practice are provided here courtesy of American Academy of Neurology

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