EHRs can help prevent, minimize or mitigate diagnostic errors, according to research published in the New England Journal of Medicine. In their paper - "Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?" - Gordon D. Schiff, MD, and David W. Bates, MD, of Brigham and Women's Hospital and Harvard School of Public Health note that this benefit is a "key selling point" for EHRs.
That's more good news for EHR supporters. But it doesn't stop there. A lot of hard work needs to be done by vendors, clinicians and legislators, according to the research authors. Bates and Schiff note that IT and clinicians need to reconceptualize documentation workflow as the next-generation EHRs are developed. Usability is critical for adoption, and the lack of usability of the system has been an area of criticism among physicians. As we strive for critical mass of EHR adoption and vendors strive for market share, developers really need to get documentation workflow in a user-friendly format. Clinicians on staff of these companies will be key to creating usable systems. Physicians overall, however, need to continue to be vocal about what documentation workflow should look like. The commentary needs to be constructive, and associations need to package and present suggestions to the vendor community.
Bates and Schiff criticize the current system in which billing codes determine how a clinician evaluates and manages their patients. Changing the system will force change and that requires the leadership of legislators, they said. I'm not entirely sure what's required of legislators if this involves billing codes. The industry is in a long, complex process of moving to ICD-10.
If EHRs are the platform upon which clinicians thoughtfully document their clinical thinking, the next crop of EHRs needs to be designed in a way that enables the capture of thoughtful documentation. Bates and Schiff called on clinicians to take back ownership of the medical record as a tool for improving patient care. If it's their tool, it needs to fit comfortably in their hands.
