How EMRs Preserve the Clinical Narrative

Doctors swimming in the EMR realm repeatedly bring up this argument: electronic medical records de-personalize care. And it’s true; we humans love stories, but computers love structure. This is one of the barriers doctors hit when trying to fit electronic systems into their already-established workflow.

Technology can be demanding and distracting, particularly when lots of sensitive data is involved. But the beauty of technology is that, if the need is great enough, technical requirements will fuse with user preferences to make something better.

For example, for years physicians have been dictating their notes with electronic devices and most clinics have been using some sort of practice management system to help manage billing and scheduling. Both systems do their jobs well separately, but problems arise when the clinical and administrative sides cross paths.

This is how many point-and-click EMRs were born: an electronic medical records system that was built from a practice management system. The interoperability problem in the practice is solved, but at the cost of productivity and even job satisfaction.

An art form that doctors miss when they chart their notes in a point-and-click EMR is the clinical narrative. To help speed up the documentation process, most EMRs have macros that you can copy and paste into similar patient encounters. This simplifies the chart documentation process, but it makes a lot of your notes look the same, a problem that can have legal ramifications as well as personal ones.

In healthcare, the solution that caters to both the technical and human needs is natural language processing (NLP), the software that allows doctors to continue to dictate their notes without having to employ a scribe. Rather than spouting out blocks of free text, the software separates this data into discrete data elements, filling in those checkboxes and drop-down menus that point-and-click EMRs love so much. Some EMRs even allow you to navigate through the software using voice, eliminating the need for mouse and keyboard almost entirely. NLP is coming ever closer to achieving that delicate balance to satisfy both technical capabilities (structure) and human preferences (storytelling).

Sometimes technology requires a change in mindset before the full benefits can be realized, but the best tools should solve your problems in a natural way, without forcing you to change how you work. Doctors are kept plenty busy taking care of patients, so it is crucial that EMRs aid, not hinder, doctors as they practice medicine.