The Single Greatest Advance in Human History

Colin Son -- I have really neat handwriting. In fact, if I dotted my ‘i’s with little hearts, you’d mistake me for a fourteen-year-old girl. Per the mythos of the profession, my handwriting should probably prohibit me from being a physician.

But not for much longer, hopefully. The days of pharmacists translating the hieroglyphics of some physician’s handwritten prescription or of illegible clinic notes should be over. Indeed, where I come from they already are, but unfortunately, not where I’ve been.

As I’ve written about in previous posts, I’m on back-to-back, month-long away rotations. Before these rotations I had never seen a paper chart in a hospital. And now I have a new found respect for the benefits of computer based medical records.

The time for full fledged electronic medical records has come. Hell, it has been here for a while. It’s just that many places haven’t gotten clued in yet apparently.

Let me be clear, I’m not arguing for some mandate for every private physician to stick an EMR system in their office. But, for large tertiary hospitals to still be using paper charts is absurd, what with the clear benefits of well designed EMR systems. It is shameful, and I don’t use that word lightly, for the health care systems I’ve rotated through recently to still be using paper charts.

I know that paper records have worked well for a long stretch of modern medicine. Ether had a nice run as well in the operating theatre. But the benefits of electronic medical records are undeniable, and I won’t even fancy a discussion with anyone who denies such.

Let me count the problems with paper records.

First, you can’t read them. I don’t know how many times I’ve had to call consulting services because you couldn’t read their notes. And who knows how many times others have had to make that call?

Second, the record is with the patient. For instance, you go to drop a note on a patient or check the patient’s recent vitals and discover that some other service has taken the patient to surgery early and the chart along with him.

Third, there is only one copy of the chart. A physical therapist can hold onto a chart for a long time, let me tell you. Health care has become so specialized, and every consulting provider needs their time with the patient’s chart. It can become a major hassle searching for the patient’s chart you need.

Fourth, you have to chart in geographic proximity to the patient. Imagine being on a floor housing many patients with polytrauma. Imagine all the services involved in those patients' care, with attendings and residents and students plus the hospital staff. Even in relatively modern facilities, there is often not enough physical room for everyone to flip open a big, bulky patient chart on a countertop or desk.

There are plenty more arguments but those outline my complaints against hard charts. And EMR solves them almost in full. In fact, this is more than a matter of convenience and efficiency, it is a matter of patient safety as well.

To be fair, EMR systems have a set of problems of their own. For instance, automation can breed complacency. In many computer based charting systems you can set up templates for notes. Then you have to wonder, is a note accurate or did the physician just forget to edit his standard template?

But EMRs bring so much to the table. Many of them warn physicians about conflicting orders (say, drug-drug interactions) or question unusual orders (say, accidentally prescribing too much of a medication). No longer is there a question about the plan of care for a particular patient. Every service can actually read every note from any computer in the hospital and often even from home.

I don’t buy the pragmatic arguments against EMRs. They tend to revolve around costs or physician opposition to change. I am hard pressed to imagine a lack of funds for an EMR system at any of the hospitals where I recently rotated, and they all are undervaluing the benefits… no matter the cost.

This is an important issue. So much so that it is very high on my checklist of things I’m looking for when I hit the residency interview trail. I’m not kidding. While it is one amongst many considerations, I feel strongly that I want to be at a program whose primary teaching sites have integrated electronic medical records.

Nowadays, it simply is an important part of patient care.