The following is a response I received to a discussion I raised on a LinkedIn group.  It’s written by Dr. Richard Lamson and is used with his permission.  I liked that it didn’t follow some of the EMR/EHR cheerleading that seems to dominate much of what’s written.

I wish I could say it was a learning “curve”, it’s just a “slope” with no asymptote in sight for many EMR products.

Well, no, I guess that’s not right. Your cardiologist will eventually get to 30/30 or so instead of 10/50, so there is an asymptote, it’s just not what it was with paper charts. Say what you will about paper charts (they’re unreliable, slow, get lost easily — all true), they’ve been refined by several generations of physicians, using technology that was well understood 200+ years ago. The data density of pen/ink on paper is very high, (think genograms, drawings of the location of lesions, etc.), the input bandwidth very high, and it is something with which we have been familiar since preschool scribbling with crayons (of course, some physicians’ charts would be improved by scribbling lessons!).

The EMR user interfaces out there are at most 10-12 years old, The input bandwidth is not very high — at most it is dictation speed but with a higher error rate. Because of copy/paste technology, a lot of “information” in charts is copied and pasted from previous notes and does not necessarily reflect what the physican did on this visit. Also, it might not be true this time. Does every doctor look at every diabetic’s feet at every visit? I try to, but when I’m 45 minutes behind sometimes I defer it to the next visit, especially when they can’t put their own shoes back on after I take them off. I try to edit out the foot exam

Don’t get me started on the warnings that EMRs give you every time you open a new patient, write a prescription, etc. You get warning fatigue and tend to blow past them without reading them after a while, since 99+% of them are not germane (oh, this patient’s taking aspirin, maybe they’ve had a heart attack in the last 10 minutes, better not write them for a migraine medication…). These warnings are basically lawsuits waiting to happen. I can hear the attorney now: “But, Doctor, your EMR warned you that this was a bad medication to use in this case, why did you write it anyway?” “Well, you see, it had given me that warning buried in among 20 other warnings, and it was probably the only warning all day that was useful, how can I read 400 warnings a day to see which one is useful?” Cha-ching!