In The Computer Will See You Now, Dr. Anne Armstrong-Coben highlights the depersonalization and mindless checkboxes of electronic health records. She identifies Tablet PCs as the way to deal with the depersonalization, but is silent on what to do about the mindless checkboxes:
Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented.
Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is “in pain,” and to restrain my potty mouth when the computer malfunctions or the screen locks up.
In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.
So before we embrace the inevitable, there should be more discussion and study of electronic records, or at a minimum acknowledgment of the downside. A hybrid may be the answer — perhaps electronic records should be kept only on tablet computers, allowing the provider to write or draw, and to face the patient.
What the writer yearns for is a clinical tool that is thinking along with the doctor, highlighting the most relevant material, and offering choices based on the information that the doctor has designated as relevant. This is exactly what SimulConsult diagnostic software does. It displays pertinent positives and negatives and it uses its database to suggest additional information, including lab tests likely to be useful and cost effective. These abilities to understand what is going on and assist intelligently are the crucial abilities needed by electronic tools to become a resource instead of a fiasco.March 6, 2009