“I just need to sign in real quick to see what’s going on!”

I have said this to newly arrived patients innumerable times in the past 10 years since the advent of electronic medical records. The computer is attached to the wall on the opposite side of the diminutive exam room, often requiring fairly deft maneuvering to get to.

My staff documents the reason the patient has come in to be seen, known as the chief complaint, and enters their blood pressure, height and weight into the visit note for the day. If I don’t log in, I have to ask the patient for the third or maybe even a fourth time why they are there, and it really takes away from the idea of working as a team.

Do you ever wonder what happens with all that information about you that is typed up every time you visit a doctor?

Cory Lum/Civil Beat

Recently, I was talking to a woman I’ve seen for almost 20 years, and she asked me a question so simple, I couldn’t believe I was stumped.

“Dr. K, has medicine actually improved with all of this typing you and your staff seem to be doing all the time?”

I was taken aback. After all, her health hadn’t changed much, she still had the same medical conditions, and was on a relatively small list of pills. Are computers helping to take better care of patients?

Some improvements are obvious. No more deciphering of a doctor’s handwriting, easy access to reading the notes of colleagues, test results in a few clicks of the mouse, x-rays to show to patients and point out abnormal findings that are easier to see than to explain.

But the downsides are many, often unseen, and usually driven by forces not related to actual patient care.

The computerization of medicine has led to several complications that do not improve overall medical care for patients. Chart inaccuracies, medication duplication, and cloned notes are just a few.

One of my colleagues pointed out that on the hospital floors, the keyboards for the computers are so well worn, that every few months they need to be replaced.

When our hospital first went onto the electronic record system, it was unclear how to put all of the information from the old paper charts into the new computer ones. Medical records staff were assigned to do some data entry, but it was mainly the doctors that were tasked with typing all of this information into the different sections of the electronic chart.

However, as with any large system, some doctors noted the diagnoses correctly, some noted symptoms only, and some didn’t note anything at all.

These days I often find incomplete documentation of surgeries that are not entered into the past surgical history, or the opposite, five diagnoses of the same condition in the same place. Diabetes, for example, listed in different ways.

Until there is a uniform way of listing medical conditions, and some type of system that double-checks the duplications, this problem will continue.

Medication duplication is another big problem with electronic medical records. Some prescriptions that were given one time are listed forever, and never deleted. Changes in dosing of medication requires not only entering in the name of the medication and sending a virtual prescription to the pharmacy, but now another step, often missed: deleting the previous medication that was discontinued, or the prior dose.

At least once a day I see medications listed that have more than one dose on file as an active prescription. Pharmacies send in faxes for refills, and it might list a completely different amount of the medicine. Patients have to be called, they wonder why it’s not correct in the computer, and staff have to waste a lot of time dealing with inaccuracies in the chart.

Notes have also become volumes of information that just go on endlessly. After all, there is no limit to how much information can be included. That golden nugget of information at the end can easily be missed in the massive amount of information. Sometimes, it’s not even there, or finding it seems impossible.

Note-cloning is another downside of the electronic records. It’s so easy to just cut/paste the previous note into the chart, and change the date or maybe the vital signs. In some cases, maybe everything is the same, but it just seems like the very fact that all of this information is needed each and every time is the problem.

For many physicians, the main driver of all of this documentation is billing. In order to get paid for their services, there are rules on what needs to be in the notes for different levels of care, and if it’s not there, then the services may not be paid for, or will be at a reduced rate. In order to prevent this from happening, any possible pertinent information is included, making the notes that used to be one page, now 10 times that long. It’s just too easy to click a few buttons and include everything, necessary or not.

One of my colleagues pointed out that on the hospital floors, the keyboards for the computers are so well worn, that every few months they need to be replaced.

The incredible demand for more documentation has also led to the creation of a whole new profession — medical scribes. These are people who follow around the doctor just to document the notes so that the physician can focus on patient care and not on the computer.

Do medical scribes improve patient care?

In the end, after my patient asked me that question, and I looked as stumped as I felt, it became clear to me that with electronic medical records there is a good side, definitely a bad side, and sometimes an ugly one too.

After folding up the keyboard and turning the computer away, we talked about how she was doing, and what was bothering her. Maybe not the most efficient way to go about charting the visit, but certainly the most pleasing one, for both of us.

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