Should the complete medical record be computerized in family practice? An opposing view.

The goal of replacing the entire paper chart with an electronic record may be a subtle barrier to the spread of computer-stored medical records. The focus on needing to replace the current paper chart draws attention away from the benefits of having parts of the record stored in a computer retrieval form. Furthermore, the focus on total computerization implies a large initial and ongoing dollar commitment to replace the record completely. This commitment is unacceptable to most practices. No doubt, there are advantages of computerizing key patient data. Only key data should be computerized, however, not all data. Patient summaries containing the patient's demographics, medical problems, allergies, health maintenance status, and recent laboratory results can be used to generate needed prevention reminders as well as to do research (such as postmarketing drug surveillance) and management (such as being able to compare the utilization of various laboratory tests by physicians). Computer searches of these data can also be used to create patient target groups and to produce individualized labels and letters to contact patients. The computer medical record should complement, not replace, the traditional office record. The computer then can be used for a subset of the full record to take advantage of its unique power of retrieval and analysis. As a supplement to the record, the computer can be implemented in a modular step-by-step fashion rather than all at once with its attendant costs. This approach implies that the goal is more effective care of patients rather than a fascination with high technology.