Law School Graduate, University of Michigan, Ann Arbor, Michigan, USA.
University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA.
Postgrad Med J. 2018 Nov;94(1117):659-661. doi: 10.1136/postgradmedj-2018-135849. Epub 2018 Dec 15.
For physicians in training and their mentors, the process of learning and teaching clinical medicine has become challenging in the electronic medical record (EMR) era. Trainees and their mentors exist in a milieu of incessant box checking and laborious documentation that has no clinical educational value, limits the time for teaching and curtails clinical cognitive skill development. These unintended consequences of the EMR are juxtaposed against the EMR's intended benefits of improved patient care and safety with reduced medical errors, improved clinical support systems, reduced potential for negligence with clinical data and metadata data supporting compliance with the standard of care. Although the mindset was technology would be the solution to many healthcare issues, there was not an appreciation of the cumulative impact of the non-educational workload on physician time and education. The EMR was intended to improve the efficiency of medical care and time management. It appears that the unintended consequences of the EMR with numerous checkboxes, automatic filling of computer screens, pre-worded templates, and automatic history and physical examination functions with detailed administrative oversight and compliance monitoring were not appreciated, and many believe that burden has overwhelmed the intended benefits of the EMR. This juxtaposition of the intended and unintended consequences of the EMR has left trainees and mentors struggling to optimise medical education and development of clinical skills while providing high-quality patient medical care. Physician educators must identify how to use the benefits of the EMR and overcome the unintended consequences. A major unintended consequence of the EMR is time dedicated to automate functions that detract from the time spent with mentors and patients. This time loss has the potential to restrict the physician from meeting the essential canons of medical informed consent and interfere with a physician meeting her fiduciary duties to the patient. To raise awareness and stimulate a search for solutions that benefit medical education and patient care, we will explore the intended and unintended consequences of the EMR and potential solutions using the intelligent systems of the EMR.
对于接受培训的医生及其导师来说，在电子病历 (EMR) 时代，学习和教授临床医学的过程变得具有挑战性。受训者及其导师所处的环境是无休止的勾选框和繁琐的文档记录，这些记录没有临床教育价值，限制了教学时间，并阻碍了临床认知技能的发展。EMR 的这些意外后果与 EMR 提高患者护理和安全性、减少医疗错误、改善临床支持系统、降低因临床数据和元数据支持符合护理标准而导致疏忽的潜在风险等预期益处形成鲜明对比。尽管人们认为技术将是解决许多医疗保健问题的方法，但他们并没有意识到非教育性工作量对医生时间和教育的累积影响。EMR 的初衷是提高医疗保健和时间管理的效率。似乎人们并没有意识到 EMR 带来的许多意料之外的后果，例如大量的勾选框、计算机屏幕的自动填充、预先拟定的模板以及自动病史和体检功能，这些都带来了详细的行政监督和合规性监测，而许多人认为这种负担已经超过了 EMR 的预期益处。这种 EMR 预期和非预期后果的并列，使得受训者和导师在努力优化医学教育和发展临床技能的同时，为患者提供高质量的医疗服务。医生教育者必须确定如何利用 EMR 的优势，并克服非预期后果。EMR 的一个主要非预期后果是，专门用于自动化功能的时间会占用与导师和患者在一起的时间。这种时间损失有可能限制医生满足医疗知情同意的基本规范，并干扰医生履行对患者的信托责任。为了提高认识并寻求有利于医学教育和患者护理的解决方案，我们将探讨 EMR 的预期和非预期后果，以及使用 EMR 的智能系统的潜在解决方案。
