Why EMRs are Backfiring

Doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click…

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.

More on how electronic medical records make some things too easy.

Comments (7)

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  1. Jeff says:

    Good post. I’m not surprised at this.

  2. Buster says:

    That’s an unintended consequence of requiring an EMR system that was not designed to fill a competitive need. If the system provided an advantage to physicians, no government agency would have to require it. But when the system serves no purpose, all the mandates in the world cannot make providers use it appropriately. The ability to cut and paste or click on “normal” means there’s an incentive to cut and paste or assess someone with a unique condition as “normal”. Likewise, requiring doctors to fill out a much of worthless check boxes that serve no medical purpose takes valuable physician time away from the patient.

  3. August says:

    The conclusion of this is not the EMRs are bad, but that the current payment system incents misuse.

    “I would never go back to the bad old days of lost charts, illegible writing, manual prescription refills and forgotten information. Electronic medical records help us avoid dangerous drug interactions and medical ordering errors, remind us to provide preventive care and allow us to view data as trends over time. Even copy and paste have legitimate uses.

    But physicians need to be better stewards of our records so they remain useful, regardless of skewed incentives and new technology. And as a nation, we should question whether paying physicians by documentation — instead of by time spent on quality patient care — is such a great idea after all.”

  4. Louise says:

    It seems there can be easy ways to fix this. I’m no programmer, but can’t you write the program so you can’t copy/paste? Remove the option to fill in a chart as normal automatically?

  5. Kyle says:

    That would be a good idea Louise, but if the EMR market is competitive.. I’m certain that hospitals would substitute.

  6. Jennifer says:

    I agree with August. I believe the conclusion here is not that EMRs are bad, but that doctors are misusing them. EMRs are there to facilitate a physician’s job. If they porperly used them they would certainly make everyone’s job easier (patients, insurers and physicians themselves.)

    Don’t hate the game, hate the player.

  7. Dennis says:

    Certainly there is misuse. But false documentation occurs with paper records as well. The bigger issue is, as alluded to by others, the inappropriate incentives created by the E&M coding system. Physicians have learned how to up code visits by gathering and documenting lots of (mostly irrelevant) data. This is easily done (e.g. with questionnaires) and is well within the law.