Oddly my thoughts today were very much in line with my last post. If electronic medical records are intended to add value, the program has to be at least as smart as I am, and optimally smarter. Instead of what I call the "trained chimp" approach to health care delivery, programs need to be developed that process input like seasoned clinicians.

Current state of the art is that most EMR's OPTIMIZE how much money can be extracted from the insurers and attempt to minimize liability (arguable since so many of the records look like nothing but drivel)- but do very little to help an experienced clinician evaluate a patient. Actually they get in the way . Most of the time I find myself putting a blank piece of paper on top of the template allowing the patient to talk- following their leads - fleshing out the history, corroborating the story with physical findings. I end up recording the data the computer wants after the day is over. So the whole process creates more work.

It would be a huge error to confine encounters to "that which fits the template". I would have missed a case of extra-pulmonary tuberculosis, if I had used the "back pain" template. Pleuritic inspiratory pain isn't mentioned on the template. Would I have been prompted to examine the patient's lungs? (I would have gotten points off for ordering the chest xray that identified the liter of fluid in the pleural space....)