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EMR Perpetuates Misinformation

Posted on March 15, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have a number of doctor friends that I know from church, scouts (yes, I’m an assistant scoutmaster), or other local group. I must admit that generally our focus is whatever activity is at hand, but every once in a while they or I will bring up the topic of EMR.

These types of discussions are especially fascinating because they give a nice insight into a doctor’s perspective from someone who’s not inside the healthcare IT bubble. You know, that bubble where we all know the difference between meaningful use stage 1 and 2, ONC-ATCB and CCHIT, and a whole set of other acronyms. Certainly these doctors know some of these terms or have at least heard of some of these terms, but they definitely don’t know all the details. In fact, that’s what makes it so interesting to see what they know and what they don’t know.

I bring all of this up because I had a short discussion with one of the really smart doctor friends of mine. When I say smart I mean it from a clinical standpoint (he’s seen me a few times), but he’s also a very smart businessman as well. So, with this respect I’m always interested to hear his take on things.

This doctor has been a user of an EMR for quite a few years. He’s quite satisfied with his EMR and in our discussion he is planning to get the Medicaid EHR incentive money. After a short discussion he stopped and told me, “John, you know the thing I dislike most about an EMR?”

Then, he proceeded to tell me, “The thing I dislike most about an EMR is that it perpetuates misinformation.”

I’d certainly considered the topic before, but I thought it was an excellent description of this EMR challenge.

Part of this reminds me of a guest post done by Dr. West about Copy and Paste in EMR (He now blogs at Happy EMR Doctor). Copy and paste has the challenge of perpetuating misinformation too. Although, I think his comment is much deeper than just copy and paste.

There’s a challenge in most EMR software to take whatever was entered as complete fact. It’s not usually as easy as putting a line through it to correct something that was entered incorrectly. There’s no reimbursement for correcting or updating records even if it’s really essential to great patient care. As a commenter on the above copy and paste post said, “It is not the machine or process, it comes down to ethics, professionalism, and accountability.”

Copy and Paste and EMR

Posted on May 20, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve seen a number of side comments on the challenges of Copy and Paste functions in an EMR. However, I’ve seen very few people really address the challenge that is copy and paste functions that are built into almost every program in the world.

Before I talk about the challenges, of copy and paste with an EMR I will first profess my amazing love for these 2 functions. I use them probably 100+ times a day. On a good day it’s probably a few hundred times and on a bad day it might only be 50 or so. I can’t imagine doing what i do without copy and paste. Even in this post I’ll likely using copy and paste a dozen or so times.

I’ll admit that I probably use it more than most. However, it’s amazing how many people use copy and paste. It’s really become a major part of computer use. The fact that it is almost automatically integrated with every application is a testament to this fact. When used right, those two functions are an amazing utility.

Of course, when used wrong it can cause some really ugly problems. In your personal life it might just be an email sent to someone with someone else’s name on it. Usually not a major problem, but a minor annoyance. Now apply that same situation to an EMR.

Let’s say you copy a nice physical exam assessment. Despite the very best of intentions, many times you’re going to forget to change something after you paste it. Yes, it happens all too often. Not purposefully of course. Usually something happens to distract you right after you paste it. Maybe the phone rings, your cell buzzes, you get an IM, the nurse comes to talk to you, etc etc etc. Each of these distractions often lead you to forget to change/add something that you just copy and pasted. I don’t need to describe why it’s a problem to have it say “normal rhythm” when it’s not normal or why having other pertinent positives missing is a major problem.

Now, this is just the most obvious case. It’s pretty easy to see how it’s easy to miss things when you start copying and pasting into an EMR. However, the EMR copy and paste challenges don’t stop there. However, the problems might not be as obvious.

One example, is how the length of EMR notes BALLOON with the use of copy and paste. Yes, that means that you might have more robust notes, but that also means that we’re missing out on the “minimum necessary” documentation which makes those notes really useful and functional. Sure, insurance billing has ruined notes in this regard, but copy and paste hasn’t helped either.

I also haven’t talked about the potential HIPAA issues related to copy and paste. I’ll save that for the lawyers out there.

It’s amazing how a function which can be so useful can also be so dangerous. Although, I guess this is true of most tools.