Are EHRs Getting All The Right Notes?

He goes on to argue that “If Epic was the only thing promoting this kind of reductionist approach, it might be survivable. But it’s not. In the face of duty-hours limits, our trainees are increasingly programmed to operate in a ‘just the facts, ma’am’ mode, to approach patients as a series of problems to be addressed expeditiously and algorithmically.” What he wants, then, from his new system is “a mandatory field, and call it ‘Über Assessment’ or ‘The Big Picture.’” 

In this field, he says, he would prompt providers to “please tell the many people who are coming to see your patient – nurses, nutritionists, social workers, consultants, your attending – what the hell is going on. What are the major issues you’re trying to address and the questions you’re struggling to answer? Describe the patient’s trajectory – is he or she getting better or worse? If worse (or not better), what are you doing to figure things out, and when might you rethink the diagnosis or your therapeutic approach and try something new?”

And the time, he says, “is now – before our trainees build habits that will be awfully hard to break – to recognize that electronic medical records do more than chronicle our patients’ histories, exams, and labs. They are also cognitive forcing functions, ever-so-subtly modifying our approach and language into something that can either improve our clinical care and teaching, or not.”...