The clinician's perspective on electronic health records and how they can affect patient care
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7449.1184 (Published 13 May 2004) Cite this as: BMJ 2004;328:1184All rapid responses
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Editor
This is, by a substantial margin, the most pleasing paper that I can
recall reading on the subject of IT implementation in health care. At
last, a recognition that the whole of a patient cannot be coded.
Hard- and software have a great distance to travel before they can
effectively emulate the best features of a consultation and make available
to the clinician the narrative, subtexts and soft data that are so crucial
in evaluating a patient.
Steven Ford
Competing interests:
None declared
Competing interests: No competing interests
Very interesting article and outlines the difficulties for all
assessors and clinicians face when creating an electronic patient/client
record.
I would point out this is not just an issue for health staff but also
social, voluntary and independent sector providers of health and social
care services. We are all used to talking to our patients and clients but
do not necessarily record these conversations and observations well in any
format. We are certainly not good at sharing information across services,
agencies and organisations and all to often information that is shared is
of a poor quality, written in jargon or abbreviated so much as to have no
meaning to anybody but the author.
The use of electronic records with a mixture of free text and coding
appears to work best providing the operational and clinical processes have
been understood in the production of the system.
We are regulated and we need to ensure we make the best use of public
monies. We also need to research where the gaps in our services are. We
need to know if we are improving the delivery of services whether that’s
assessments and diagnosis or treatment and care plan. Management
information produced electronically can help organisations carry out this
important task. However it is then incumbent on the person inputting
information to do this as accurately as they can. We often forget that it
not just the patient/client that information is important for. The saying
rubbish in rubbish out comes to mind.
I would agree that any system used should be kept as simple as
possible as most of us aren’t computer geniuses and for many it a skill we
are reluctantly learning on the job.
I guess what we have to ensure is that whatever systems are developed
over the coming decade are developed with the patient/client and
clinician/assessor in mind. Not just a system that looks good, delivered
on time at great cost and are so technically advanced it is impossible for
anybody who is not an IT wizard use.
It will be interesting to see what transpires
Competing interests:
None declared
Competing interests: No competing interests
The author sums up many of the misgivings that those of us who are used to using electronic records in medicine have about the current wave of enthusiasm for a big bucks big bang computerisation of the NHS.
But the picture of a computer being used is very different from the curent consultation in general practice.
Presumably it was a stock photo.
Put the patient and the clinician - or even the clerk - at the apices of a triangle, such that each can see the screen.
Competing interests:
Sometimes people pay me for advice on this sort of thing
Competing interests: No competing interests
Facilitating Data Entry
I am writing in response specifically to a section of your article
regarding the various intricacies and complexities involved in the data
entry procedure.
As you are no doubt aware, we are entering into the Rio system with
varying amounts of apprehension, one of which raised by many of my junior
doctor colleagues is the effect it would have upon their time-managment,
with special focus on the sometimes large amounts of text which will need
to be entered on the Rio system.
I have been working on a Voice Recognition Software package
championed by my Consultant, which has drastically reduced my time spent
typing long entries.
I am also conducting a survey to see how the Voice Recognition
Software responds to a variety of different accents and backgrounds, which
we obviously have within our multinational NHS!
The results have been very positive on all counts, and the ease and
speed of data entry has improved by a subjective estimate of 300%, and
also allowed us to use the software in a variety of situations including
emergency assesments and Outpatients Clinics.
I have no declaration of interest and I have intentionally omitted
the trade name of the Software we used, but as the software is constantly
improving, I am sure that such software will greatly facilitate the huge
amounts of electronic data entry we now face with the impending change.
Also, I know that this will contribute greatly to the viewing of the
patient as a whole entity with more data being able to be entered with
less effort.
Competing interests:
None declared
Competing interests: No competing interests