Letters To The Editor

Electronic medical records

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To the Editor: Like Dr. Hanlon (Cleve Clin J Med 2010; 77:408–411), I too am alarmed by the inability of electronic medical records to incorporate whole language. Physicians can make treatment errors when they fail to include contextual factors in their diagnosis and treatment plans. The social and circumstantial complexities of a patient’s life cannot be parsed by computer systems that can only “search” bullet points. The current template-driven systems were originally designed for billing and now are touted for “quality measurements.” They could tell us whether a patient’s hemoglobin A1c was at goal, or if she was “noncompliant” and hadn’t filled a prescription; they could not tell us that a psychologically abusive husband would not allow her to purchase her diabetes medications (this actually happened to one of my patients). I would argue that addressing the abuse is more important to her health. Yet we are all being pushed, like teachers teaching to a standardized test, to hit certain “benchmarks,” in order to be called “quality” physicians.

Since it is unlikely that the tide will turn back to a written record, physicians should be demanding rapid deployment of computer systems, now in development, that can analyze whole language and find information in context. This technology is out there and needs aggressive support.

Texting contractions, Twitter, and the rest are chipping away at the concept of narrative. Our patients’ lives are worthy of a narrative, not the bullet points and cut-and-paste we are forcing their lives and health into.

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