It was a pessimistic reading the editorial by Loder [1] as well as confusing comparing the electronic version to the paper version.
In the paper copy, there is a reference to US doctors spending too much time in the computer [2] while the online version links to another article about time allocation in a Swiss hospital [3]. In both cases there seems to be more time doing computer work than face to face work, and whether there are almost double [2] or almost triple [3] number of hours that are spent doing computer work, it gives the impression that electronic health records (EHR) are preventing clinicians to care after their patients, rather than actually reflecting these clinicians are more efficient and being able to manage the complexity of medicine today.
This circumstance was simply summarized by Chantler [4] when he stated “Medicine used to be simple, ineffective, and relatively safe. It is now complex, effective, and potentially dangerous”.
The fact is without EHR, without interlinking even more the different organisations that look after every single patient, medical errors will be more common.
Suggesting as the editorial does, that increasing digital connectivity will increase cost and demand is not only wrong (the cost of clinical error is much greater, demand increase is multifactorial) but also disappointing.
EHR are the basics to get digital diagnostic tools that help clinicians to make adequate and tailored diagnoses and management plans, and we are still at very early stages, with concerns about changes in attitudes and ways of work as well as regarding data quality [5, 6]. It is a long road ahead; an expensive journey, but paper records have long passed their expiry date [7] and we need to invest to make from the art of medicine a more accurate science, where iatrogenic effects are reduced and the ever growing demand of longer living patients can benefit from safer 21st century medicine
References:
1. Loder, E (2017) Promises, promises. BMJ 356(8098) p. j1446
2. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, Westbrook J, Tutty M, & Blike G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med, 165(11), 753-760.
3. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, & Garnier A (2017). Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening ShiftsAllocation of Internal Medicine Resident Time in a Swiss Hospital. Annals of Internal Medicine. doi: 10.7326/M16-2238
4. Chantler, S. C. (1998). BMJ : British Medical Journal, 317(7173), 1666.
5. Reimer, A. P., Milinovich, A., & Madigan, E. A. (2016). Data quality assessment framework to assess electronic medical record data for use in research. International journal of medical informatics, 90, 40-47.
6. Singer, A., Yakubovich, S., Kroeker, A. L., Dufault, B., Duarte, R., & Katz, A. (2016). Data quality of electronic medical records in Manitoba: do problem lists accurately reflect chronic disease billing diagnoses?. Journal of the American Medical Informatics Association, 23(6), 1107-1112.
7. CMAJ Editorial (2005). Have paper records passed their expiry date? , CMAJ Vol 173(7) p. 725.
Rapid Response:
Optimism promised
It was a pessimistic reading the editorial by Loder [1] as well as confusing comparing the electronic version to the paper version.
In the paper copy, there is a reference to US doctors spending too much time in the computer [2] while the online version links to another article about time allocation in a Swiss hospital [3]. In both cases there seems to be more time doing computer work than face to face work, and whether there are almost double [2] or almost triple [3] number of hours that are spent doing computer work, it gives the impression that electronic health records (EHR) are preventing clinicians to care after their patients, rather than actually reflecting these clinicians are more efficient and being able to manage the complexity of medicine today.
This circumstance was simply summarized by Chantler [4] when he stated “Medicine used to be simple, ineffective, and relatively safe. It is now complex, effective, and potentially dangerous”.
The fact is without EHR, without interlinking even more the different organisations that look after every single patient, medical errors will be more common.
Suggesting as the editorial does, that increasing digital connectivity will increase cost and demand is not only wrong (the cost of clinical error is much greater, demand increase is multifactorial) but also disappointing.
EHR are the basics to get digital diagnostic tools that help clinicians to make adequate and tailored diagnoses and management plans, and we are still at very early stages, with concerns about changes in attitudes and ways of work as well as regarding data quality [5, 6]. It is a long road ahead; an expensive journey, but paper records have long passed their expiry date [7] and we need to invest to make from the art of medicine a more accurate science, where iatrogenic effects are reduced and the ever growing demand of longer living patients can benefit from safer 21st century medicine
References:
1. Loder, E (2017) Promises, promises. BMJ 356(8098) p. j1446
2. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, Westbrook J, Tutty M, & Blike G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med, 165(11), 753-760.
3. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, & Garnier A (2017). Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening ShiftsAllocation of Internal Medicine Resident Time in a Swiss Hospital. Annals of Internal Medicine. doi: 10.7326/M16-2238
4. Chantler, S. C. (1998). BMJ : British Medical Journal, 317(7173), 1666.
5. Reimer, A. P., Milinovich, A., & Madigan, E. A. (2016). Data quality assessment framework to assess electronic medical record data for use in research. International journal of medical informatics, 90, 40-47.
6. Singer, A., Yakubovich, S., Kroeker, A. L., Dufault, B., Duarte, R., & Katz, A. (2016). Data quality of electronic medical records in Manitoba: do problem lists accurately reflect chronic disease billing diagnoses?. Journal of the American Medical Informatics Association, 23(6), 1107-1112.
7. CMAJ Editorial (2005). Have paper records passed their expiry date? , CMAJ Vol 173(7) p. 725.
Competing interests: No competing interests