- Filtering, organizing and providing acces to information...the problem of having too much information is now surpassing that of having too little, and it will become increasingly difficult to review all the patient information that is available.
- Serving as a place where clinicians, together with patients, document succinct evaluations, craft thoughtul differential diagnoses, and note unanswered questions.
- Facilitate the documentation of evolving history and ongoing assesment.
- Managing problem lists ... The failure to effectively integrate the creation, updating, reorganization and inactivation of items on problem lists into the clinician's workflow has been one of the great failures of clinical informatics.
- EHRs should ensure fail-safe communication and action in the areas of ordering tests and tracking the results.
- Electronic systems should incorporate checklist prompts to make sure that key questions are asked and relevant diagnoses considered.
- Electronic systems should do more to help with follow-up and the systematic oversight of feedback on diagnostic accuracy.
They conclude with the observation that "clinicians need to take back ownership of the medical record as a tool for improving patient care."
Needless to say, I agree. Our current medical records serve the purpose of billers, auditors and attorneys. They communicate poorly amongst the patient care team, and don't facilitate recording of pertinent observations, highlighting them and annotating these observations. Both in the paper and in the electronic world, there is too much cut and paste or re-dictation of previously recorded information. Record creation and review has turned into a time-sink with minimal value creation.
In addition, psychiatrist Deborah Peel, in an op-ed piece in today's Wall Street Journal (here) entitled "Your Medical Records Aren't Secure" and with the sub-head "The president says electronic systems will reduce costs and improve quality, but they could undermine good care if people are afraid to confide in their doctors," makes the point that security breaches and other data leaks could undermine patient's confidence in their doctors and their associated EHRs.
I suppose a psychiatrist, because of the problems with whiche she deals, would be especially sensitive to this issue, but she alerts us all. In the system in use where I work, accessing sensitive information (HIV results, HLA typing, psychiatry consults) is preceeded by a pop-up warning that access is being monitored. We have had at least two people terminated from employment in our cancer center in the recent past for breaching fellow employee's medical records, so the audit trail system does work. However, I can see Dr. Peel's point; I remain concerned about security breaches. Perhaps some of the stimulus borrowing money can be put to use beefing up patient-related information security systems as Dr. Peel suggests.