Thursday, April 10, 2008


Lets be honest, the paper medical chart is on the way out, and probably for good reason. Electronic charts have the capability of moving the chart from being mainly an archive of information to being a tool for communication and error prevention. Electronic medical records are slowly but surely supplanting paper charts. Here in Canada many provinces are offering incentives for physicians to adopt new technology, and physicians are slowly integrating electronic records into their practices. In the north the eventual disappearance of paper charts will mean better communications between nurses in remote stations, physicians in hospitals and specialists in the south. It will improve care planning, meds prescribing, and hopefully patient care.

Even though I see the benefits of electronic charts I remain attached to the paper versions. Here in the north many charts stretch over an entire lifetime. In the back of many charts I'll find thin typewriter paper from the 1950's and 60's with interesting notes from the past. Medical charting of yore was very different than the notes of today. Recently I stumbled across a note that read 'Hospitalized for bacterial meningitis. Fully recovered.' That was it, the full hospital admission, and discharge summary in one simple line. It probably wouldn't be considered particularly adequate these days.

Paper charts can be part of a tale of the ups and downs of a life well lived. One of the great thrills I get here in northern practice is to see a single volume chart on a 60ish year old patient. In the back there is a birth note on thin and fragile typewriter paper, lists of childhood immunizations, notes about hospitalizations for serious illnesses that still add weight to the conversation, delivery notes about the patients own children, office notes about the stress of raising teenagers, chronic diseases, aging. Then I look up from the chart, a story of a lifetime, and see the smiling face of a patient. Oolakoot!! (goodmorning!).


Ian Furst said...

Nice having charts that go back 50 years. It's like reading a good novel. On a serious note though with EMR -- imagine how that meningitis would clog the chart/slow down the reading and distract you from the real problem. With that little note you learned all you really needed to know. Agree? Not to say the EMR is wrong (I can see it being extremely useful with remote sites) but good summarization and "readability" will become extremely important.

Dr. J. said...

Good point Ian! In the EMRs I have used one of the WORST features has been automatic generation of referrals to specialists....pages and pages of unorganized information when all the specialist really wants is "Can you please see this patient about her gallstones?".
More is not always better where information is concerned...

everdream said...

I think the optimum settings for an EMR would be a summary page or dashboard with drill down capability. We use an EMR (Meditech) at my organization and this dashboard idea is implemented, though in a very "clunky" manner. I like the idea, but its implementation / design / delivery could be improved upon. I'm not a clinician or care provider though, I'm a geek and part of the IT support department. I see things from a different set of eyes.

Chrisss said...

Stumbled on your blog, here interesting reading. Will visit again.

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