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Research

Adverse inpatient outcomes during the transition to a new electronic health record system: observational study

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3835 (Published 28 July 2016) Cite this as: BMJ 2016;354:i3835

The holy grail for the digital messiah. Is It Worth It?

Many doctors are early technology adaptors and most would willingly embrace new technology if it improves patient care or makes their working life better.[1]

In the past decades, the gradual implementation of electronic pathology and radiology reports was universally welcomed because it made a positive impact on patient care and saved the doctors from the frustrating chore of chasing routine blood results over telephone.

But the current rapid implementation of fully digital health records is driven by the financial managers who want an electronic record of all clinical encounters for coding nirvana and aided by administrative managers who seem to have a messianic belief in the digital lord.

The current digitisation strategy has certainly made working life of doctors and nurses more difficult.[2] The scanned electronic copies of old medical notes are difficult to navigate in busy outpatient clinics. Productivity is being impaired by clunky user-unfriendly software programs. The creaky old hospital computers struggle with multiple standalone software programs.(eg separate software programs exist for blood results, radiology images, chemotherapy prescription, radiotherapy outlining, radiotherapy prescription, inpatient daily observations and digital dictation in addition to the digital health record).

More importantly, electronic health records force doctors to interact more with their computers rather than with the patients during consultations.[3]

Millions are being spent on implementation of electronic health records and the cost benefit ratio in the context of a single national payer such as NHS in UK is dubious. [4] [5]

References
1 Barnett ML, Mehrotra A, Jena AB. Adverse inpatient outcomes during the transition to a new electronic health record system: observational study. BMJ 2016;354:i3835. doi:10.1136/bmj.i3835
2 Meigs SL, Solomon M. Electronic Health Record Use a Bitter Pill for Many Physicians. Perspect Health Inf Manag AHIMA Am Health Inf Manag Assoc 2016;13:1d.
3 Asan O, D Smith P, Montague E. More screen time, less face time - implications for EHR design. J Eval Clin Pract 2014;20:896–901. doi:10.1111/jep.12182
4 Street RL, Liu L, Farber NJ, et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Educ Couns 2014;96:315–9. doi:10.1016/j.pec.2014.05.004
5 Howley MJ, Chou EY, Hansen N, et al. The long-term financial impact of electronic health record implementation. J Am Med Inform Assoc JAMIA 2015;22:443–52. doi:10.1136/amiajnl-2014-002686

Competing interests: No competing interests

05 August 2016
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital NHS Trust