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Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems were developed to satisfy several important needs (I will use EMR and EHR interchangeably). Just to name a few: legible documentation of patient encounters, satisfaction of coding and billing requirements, regulatory compliance, prevention of medication errors, clinical pathway utilization, medical-legal defensibility, and data compilation. Having seen and used several EMR systems, I can tell you that they were not developed with the primary goal of improving user efficiency.

As a follow-up to last week’s article The History of EMRs: Opportunities to Improve Patient Safety, we explore the philosophy around providing EHR documentation templates that include specialty-specific, chief complaint clinical content. Doing so provokes a few big-picture questions about healthcare information technology and the appropriate strategy for designing clinical applications that providers work with daily.

Over the next eight weeks, we will be providing information on EHRs/EMRs that have proven to improve patient safety, reduce medical errors and reduce litigation. In this first week, we provide historical context on the events leading up to today’s current state of electronic provider documentation. This series aims to help shed light on the improvements available for EMR physician documentation and to provide key takeaways to implement into your providers’ workflow.

Although most of The Sullivan Group’s RSQ® Solutions platform is delivered online via CME/CE courses and clinical performance assessments, there is another major component to the RSQ® Cycle, which involves building clinical risk mitigation strategies directly into the EMR. In 2010, one of our largest clients requested that we develop a library of physician documentation templates for their enterprise EHR system, which happened to be MEDITECH. After several years of development with their medical leadership team, we deployed 137 chief complaint-specific templates with clinical decision support to all 163 emergency departments. Below we have included 2 videos from our President & CEO, Dan Sullivan, MD, JD, FACEP, that outline a few different workflows that can be used by providers to complete their documentation with our PDoc Templates.

With HITECH in full swing and hospitals and health systems across the nation implementing electronic medical record systems, some for the first time, many are finding that the MEDITECH solution, while fantastic for billing, coding and reporting, perhaps leaves a little to be desired where the end-users in the ED are concerned. Many ED providers accustomed to structured paper chart templates found themselves essentially unsupported on the EMR front. Answering the call for , we developed RSQ® Modules for EMRs solution. 

Physician workflow frustrations are cited by several studies as a significant contributing factor to physician burnout, an epidemic estimated to impact 51% of the physician population according to Medscape’s 2017 study. Because burnout can be tied to risks in patient safety, improvements in physician workflow are key components in the patient safety movement. 

Over the decades, physicians have worked with various medical record documentation styles. While this evolution is thought to improve patient care with each step, the majority of physicians and health systems have yet to maximize the potential of their documentation to improve patient safety. Moreover, each evolution might also be cited as being more complicated and time consuming for the physician, thus adding to their workflow frustrations.

The Dangerous Discrepancies

One of the most difficult hurdles to overcome during the defense of a malpractice suit is a significant discrepancy in the medical record. The discrepancies may involve the nurses, physicians, advanced practice clinicians, EMS personnel, and any records related to the patient. Often, a discrepancy may be nothing more than a minor difference in terminology; but the cases reviewed here reveal serious discrepancies between the physician and the nurse chart in the first case and the physician and EMS record in the second case.

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” -- President George W. Bush, State of the Union Address, January 20, 2004

The move towards the electronic health record (EHR) has been under way for more than a decade now. Hospital administrators, healthcare insurers, IT vendors and government officials are touting the benefits of transitioning from paper to electronic records.

A Promise Unfulfilled

What exactly was the promise of the electronic medical record? The tool that was supposed to make life easier, workflow faster, quality of care better, and patients’ lives healthier has pretty much turned into a face-plant; a promise unfulfilled. Although there are some notable exceptions, the market has shifted to the large electronic health record companies, and medical record content and speed and quality are not their highest priority.

Given that proven effective solutions exist today, why haven't more institutions implemented programs that have proven to reduce diagnostic errors?

I listened with great interest to the interview conducted by Dr. Robert Wachter with Dr. Mark Graber in the January 2016 podcast of “Perspectives on Safety,” also published in the AHRQ PSNet.