A number of items in your magazine have recently dealt with computerization or lack of it in physicians’ offices. Similar items in the press have also alluded to this issue with the general trend of thought being that paper-based offices are antediluvian and computerization of offices, including patients’ records, would solve most of our problems.
My experience with computerized patients’ records has not, in general, been a happy one. I receive copies of computerized records from various offices as part of referral material. I have seen two different test results scanned into the same patient’s record, one normal and one grossly abnormal, and had no way of tracing which result was correct. I get laboratory results that have been scanned and have no way of identifying where the tests were actually done or the normal values pertaining to them.
Echocardiographic results are often scanned without the measurements and there is no way to compare them with old tests. Sometimes omissions are quite subtle, such as the name of the reporting physician, which can be significant. I have seen errors as gross as only one page of a two-page consult being scanned into a record. In some clinics ECG tracings are not kept and only the reports are scanned into the patient’s record, thus there is no way of comparing current studies with old ones.
That problems exist has been tacitly acknowledged by at least one clinic that sent me a note in their covering letter saying that, “they were not responsible for the accuracy of the enclosed information.”
I am sure computerization is an excellent idea if done right. I personally have two computers in my office that I use for word processing, e-mail, web searches, etc. However, I am not convinced that computerized medical records are at a stage where they can be usefully adopted by my practice. I am able to access X-ray images from my office and my home which is a major advancement and help in patient management. I dearly wish to be able to access patients’ laboratory results directly, both past and present, but sadly, this appears to be impossible at the present time.
From the perspective of being a patient, I continue to hoard my family’s and my medical information in paper form in a filing cabinet at home.
As with any new idea, God is in the details. I feel that there is a long way to go with computerized patient records.
—M. Koblic, MD
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