Business Week Article: Between You, The Doctor, And The PC

For those of you interested in the increased growth of electronic medical record systems, the advantages/disadvantages, etc. You may want to read an article appearing in Business Week Online.



The article states that right now only about 15% of U.S. hospitals and doctors are using such systems. This percentage will certain increase over the coming years as more provider decide to shift from paper to electronic health records.



One reason that I believe there is value in making the transition is based on the likelihood of reduced medical errors due to problematic physician and other health care professional handwriting. The article cites a 1998 Journal of American Medical Association article saying that serious medication errors fell by 55% when orders were typed into the computer rather than handwritten by doctors. I have seen similar studies in other articles I have read.



As a health care attorney who reads physician handwriting on a daily basis -- I certainly think the health care system would benefit by getting away from handwritten notes. Although at times there is something very personal and beneficial to handwritten physician notes. Certain things come across better in handwritten notes that don't come across in typed notes. At times typed notes seem sterile and less "patient caring" oriented. For example, when defending a physician on issues that arise or are supported by their personal handwritten progress notes -- there is something comforting (when the physician is skilled at documenting his patient encounter) when defending a physician based upon his personal notes. I have not found this to be as true with electronically typed notes.



On the issue of privacy and handwritten vs. electronic medical records I often use a story told by my father, who I consider to be the quintessential "West Virginia country doctor". He practiced family medicine in New Martinsville, West Virginia from the early 1950s through the mid 1990s. He and his brother had a family practice located adjacent to the old Wetzel County Hospital.



One day back in 2002 I was discussing with him the advent of the new "HIPAA privacy laws" and he proceeded to tell me about a old country doctor from Wetzel County who was well known at the hospital and among the local medical community to have the worst handwriting of any doctor in the area. [Note: This story coming from a man who when I was growing up would leave notes on the refrigerator about where he would be and we would have to spend hours trying to decipher the message and when he would be back.] Well at some point the local hospital and a number of the doctors who had to work with this "note-torious" doctor had had enough of his poor handwriting and selected someone from the medical staff to approach him and suggest that he improve his handwriting. When approached about the concern he notified the chair of the medical staff that he was only looking out for the best interest of his patients is such a small community as New Martinsville. He said his writing was difficult to read and illegible to most because he was protecting his patient's privacy. He thought that too many people at the hospital already knew too much about his patients and he wanted to further protect the information. He didn't want just anyone to be able to pick up a chart and read the personal information that he wrote about his patients -- he wanted only those individuals who had a true "need to know" to be able to read the information. I've often thought of this story when considering today's privacy issues in health care. I find it a novel way to address meeting today's "minimum necessary" standard under the HIPAA privacy standard rules. It also serves as an altruistic excuse for physicians who don't want to improve their penmanship.