"Dr Sevilla, I have a question for you," a patient asked me this week. "I'm going to tell you something, but I DO NOT want it put in the chart." Hmmm, I asked myself, can I really do that? It's the patient's wish, right?
The patient went on to tell me that she heard about this week's story about a hospital network being hacked and 4.5 million records being stolen. "What if that was my information?," the patient asked. "Does that mean that information in an electronic medical record could be out there for anyone to see?"
"How do I know your server won't be hacked?" the patient went on to say. "Doctor, what if I asked you to not put this in the electronic record, and to put this in my old manila folder paper chart?" Can you imagine the disruption of trying to maintain a digital chart, and also going back to maintaining a paper chart as well?
Much has been written about the inadequacies of the digital medical record, but as more and more digital medical records breaches occur (and I'm not even going to touch on the security flaws of Healthcare.Gov), how comfortable will patients be in giving medical and non-medical (ie-financial) information?
Just a few observations on why I think we're coming to the end of the utility of the medical chart:
- Loss on the Story and Narrative: Back when I was a first year medical student 20 years ago, the most important thing was recording the patient's story in the medical record. For example, to be as specific as possible in who, what, were, when and why the patient was having their symptoms. In today's digital world, when I read a medical student or resident note, it's like reading twitter. Very brief, vague, and not really that useful. I think we, as medical professionals, have lost the art of telling the story of our patients because of the digital record.
- The Medical Record as a source of billing and false accountability: Now, I'm not the first person to say this, but the medical record has become a place, literally, to check the box and less a place to really come up with the solution for patients. Many believe that the electronic medical record is a way for "big brother" (whomever that is) to keep an eye on clinicians, and eventually find a way to compensate less. My cynical mind is slowly (and reluctantly) agreeing with this point of view
- Security Breaches will become MORE and not less frequent: I predict that there will be a coming wave of concern to the point where patients will insist that certain medical data NOT be recorded in the electronic health record. What will the clinician do at that point? Do we follow the "patient centered" model because that is what is being emphasized now? Or, do we follow the medico legal fears and record it anyway for fear of being sued for an incomplete medical record?
Of course, I'll have comments and tweets telling me I'm overreacting. And, still other tweets telling me that they have been saying things like this all along. Is this the future of medicine? Is this the future of medical care in America? This is not what I signed up for, and I'm mad, and sad, at the same time. All I wanted to do is take care of patients, and hopefully have an impact in their lives. It seems more and more that is becoming more difficult...