Health information technology (health IT, HIT) is generally the realm of patient information and patient data. Certified electronic health records (EHR) are the official tool of the federal government for recording and managing patient information.
EHRs literally change how that patient information is recorded, and that meaningful use by clinicians shifts perceptions, can obscure important details, and modifies the interactions of clinicians attending to patients. This technology is not neutral. EHRs have fundamentally altered the practice of medicine.
Electronic health records are not limited to just records and the storing of patient information, but extend to how clinicians practice medicine with patient information. Unlike pen and paper, software can directly tell a clinician how to practice medicine. Clinicians are led to believe that the computer knows medicine better than they do.
In reality, while a computer can hold medical information about patients and how to practice medicine, computer programmers are not trained in the practice of medicine. IT developers and medical providers speak different languages. A computer programmer does not know how different pieces of medical information relate to one another. This is interfering with the practice of medicine. The user interfaces that programmers design do not reflect how medicine is practiced, and the very requirement of attending to the information needs of the system diminishes clinician attention to the patient.
For clinicians, the computerization of medical records raises a host of medical, ethical and legal questions.
- Deborah Burger, a registered nurse for more than 30 years who works with pain medicines and anti-anxiety drugs for colonoscopy patients, said electronic systems offered “drop-down menus of so-called best practices.” “The problem is each patient is an individual,” said Ms. Burger, who is president of the California Nurses Association. “We need the ability to change that care plan, based on age and sex and other factors.”
- The press often proclaims that nurse practitioners can replace doctors. There is a role for the NP and we need to support that role. But to suggest that someone with two years of training can provide equivalent care to that of a physician who, after college, has spent four years in medical school, three to four years in residency (working days and nights), and who, each day, makes hundreds of decisions for which he or she is ultimately responsible is not only wrong, it disrespects the training and ability of the physician.