Wednesday, 29 October 2014

The Electronic Medical Record.

          Now that I'm retired I have time to reflect on many medical issues that  practicing medicine left me limited time to consider.  The results we see today of allowing many of the crucial decisions of medical care, other than the actual practice of medicine to fall into the hands of ill equipped and often ill-informed politicians and administrators is beneficial to neither patients nor practitioners.  The electronic medical record can be a great asset to medical practice or a net liability.
          Very early in my career I recognized the gross inadequacy of medical records in general practice and elsewhere and soon after entering academe in the 70s, I made a study of Lawrence Weeds Problem Oriented Medical Record.  Weed, a Systems Analyst, before he became a physician, pointed out that the disorganized, incomplete, disjointed and often illegible records which physicians kept were unsuitable for adequately defining the problems of the patient and did not lend itself to logically progressing from the problems enumerated by the patient to a diagnostic plan to a diagnosis to a treatment plan.
          Recently, I have been considering the contemporary electronic medical record of which I was an enthusiastic innovator in the Department of Family Medicine at the University of Saskatchewan and the Department at the University of Western Ontario, where I introduced the first functional system in family medicine at the teaching clinic at the South West Middlesex Clinic where I was Director for a number of years.
          There is no doubt that computerized medical records have much to offer both patients and physicians when properly directed towards health care.   There is also no doubt that administrators want a lot more than that.  They want to control finances, they want to control how health care dollars are allocated and want them distributed according to their priorities.  They want to control medical priorities.  
          The prime purpose of the EMR must be to facilitate patient care and to assist physicians in collecting, collating and distributing medical data and scheduling patient care.  Everything else is secondary.  
          I want to know what my fellow physicians think of this, and how patients and physicians feel that it effects the doctor patient relationship, so I'm going to investigate the current state of the art.  I  want to explore the advantages and disadvantages of using an electronic record.

           Let me know if you care!


  1. I thought it ironic the other day that a computer cart and nurse were wedged so effectively between me and the patient that I had no physical access at all...

  2. You hit on a crucial issue when you note the different priorities of patients and administrators. In my professional capacity I see research on medical affairs from a cost containment perspective. I get nervous when I see some of the terminology used by administrative researchers - one of the recent notable expressions I saw was "bed occupiers". This depersonalization does not bode well for the patient care approach.

  3. Comment 1: Well, lose a little weight!
    Comment 2 :Only one step away from "bodies"(Hot or cold could be used as a qualifier!). At least it's easier to get rid of the cold ones. They never complain about being discharged too early!

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