Is Your EMR Charting Accurately?

Posted on August 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

For all the hope — not to mention time and money — being invested in EMRs as a way to improve health care, they’re still exquisitely prone to the age-old problem in IT: garbage in, garbage out.

Several writers have commented recently on whether you can believe what you read in an EMR. They raise serious questions as meaningful use Stage 2 draws near and providers’ care patterns become further enmeshed with their record systems.

One problem, wrote Dr. Rebecca Bechhold, a medical oncologist, is the information overload that an EMR can generate: “page after page of predetermined queries and stock answers that are repetitive and irrelevant after the first visit.” The truth, as in what’s really going on with the patient, might be in there somewhere, but she finds it hard to dig out.

Worse still, doctors sometimes just check “normal” for everything under the physical exam section because they’re in a hurry and entering the information is tedious, Bechhold wrote. Some pretty important history, such as an enlarged liver or an amputation, can be left out.

It might sound bad, but it’s human nature whenever there are too many boxes to check. However, for Bechhold, the key disadvantage isn’t a lack of facts, but of feelings.

“You cannot express the emotion and anxiety that is part of oncology care in a prepackaged document,” she wrote.

Software selection consultant Sheldon Needle, meanwhile, wrote about the pitfalls of taking an EMR prescription list at face value.

Take the patient who comes to the emergency room because of a car accident. If the patient’s regular doctor is linked with the hospital’s e-prescription system, a medication list might soon be forthcoming. But who’s to say there aren’t other medications in the picture, prescriptions written by a doctor who’s not tied in?

Needle’s advice: Ask a human, such as the patient or a relative.

“If something looks off on the electronic medical record,” he wrote, “question it.”’s own John Lynn, too, addressed the issue of trusting health care data, noting that doctors are receiving information from more sources than ever, including health information exchanges, patients and patient devices. It’s hard for physicians to know what’s reliable.

The obvious solution to trust issues seems to lie in user interface design. If the EMR is a good fit for the doctor’s workflow, the right data should end up in there.

Unfortunately, it’s not quite that simple. Bechhold noted that charts she receives from other doctors are sometimes configured to include every piece of data available for the patient, including all medications and test results.

The physicians, she wrote, want to be able to show that they reviewed all information if they’re ever sued.

Doctors and health IT companies have a way to go in understanding each other. Only then can there be full trust in EMRs.