Stethoscopes, EMRs and EHRs – what is all the data worth? Volume 1

I had a conversation recently with colleagues from pediatric, cardiology and surgery that gave me some ideas about the pertinence of EMRs, EHRs and what the value of all the data is worth.

From time to time, I have had to access medical records from my pediatrician who treated me from cradle until legal drinking age, at which time he retired from clinical practice after 40 years.  All of the vaccinations, well child visits, school physicals, sport clearances, and acute illnesses are recorded.  Along the way there were spiking fevers, bouts of otitis media, pneumonia, bronchitis, broken bones, fractures, viral pericarditis and acute appendicitis.  Changes to our home address and phone numbers were penciled in above the old crossed out ones as visits occurred.  Some are sideways and poorly written, but still legible on faxed copies. 

The records contain the date and time of visit, who attended the visit, clinical history, pertinent physical examination findings, laboratory and radiologic studies (few performed), diagnosis, treatment, resolution, complications if any, with documentation about management and notes pertaining to follow up phone calls from the physician (not a nurse or PA).

The entire medical record is 1 1/2 pages (both sides).  It is complete, accurate, thorough and relevant.  The pediatrician has been retired for years, the practice sold three times since and the records still appropriately filed and available. 

Have you tried to access your medical records or a family members from an EMR?  A years worth of well baby visits without acute illness yields 58 pages, contains mostly templated histories and physicals that are cut and pasted, repeated each visit, along with immunizations to date (repeated), demographic information (repeated each time on each visit, without changes).  The amount of pertinent information might amount to 3 typed pages. 

To review the endoscopic findings for a GI biopsy, I have to log onto a different system (dual monitors and synchronized passwords help this a lot), enter a number different than the accession # and scroll through tabs and columns of other data – ER visits from last year, social work consults and radiology results from other organ systems before I can open "procedure notes" for the current biopsy.  This is not to say all of that information may not be relevant, but it is likely less relevant than the information I need for a directed problem and procedure. 

While we talk about managing disparate data and merging all the information into a succint record, we have moved from talking about EMRs to EHRs with daily headlines and the promise of having all the infromation in one place.  My experience is most EMRs contain a lot of redundant information, often inaccurate, cut and pasted time and time again, not temporally relevant to the current problem and all of that information masks pertinent answers for health care providers in their respective subspecialties to the questions at hand, while losing the big picture and missing important details. 

The examples of this are endless but does a radiologist really need 5 years worth of normal CBCs while evaluating a chest x-ray for acute shortness of breath?  Certainly a hematopathologist may query that information but does he/she need to scroll through tabs for series of ankle x-rays from 5 years ago for an acute problem?