Electronic Medical Records Make It Harder to Understand the Patient’s Story

MedicalResearch.com Interview with:
Lara Varpio, PhD
Associate Professor, Department of Medicine
Acting Associate Director, Graduate Programs in Health Professions Education
Uniformed Services University of the Health Sciences
Bethesda MD and
Dr. Judy Rashotte PhD
Director Nursing Research and Knowledge Translation Consultant  
Ottawa Canada

Medical Research: What is the background for this study?

Drs. Varpio and Rashotte: Electronic health records (EHRs) are being adopted in healthcare centers around the world. The patient record is intricately implicated in care processes, clinical reasoning activities, and in collaborative work. As part of a larger study aimed at understanding how EHRs impact health professionals’ interprofessional collaborative practice (ICP), we explored how changing from a paper chart to an EHR can impact clinical reasoning.

Medical Research: What are the main findings?

Drs. Varpio and Rashotte: Our research demonstrated how different parts of the patient record (i.e. communication genres / artefacts) are part of the contextual factors that influence clinical reasoning and ICP. A key finding of our study is that building the patient’s story is an essential part of clinical reasoning activities. Making and understanding data interconnections is facilitated when clinicians are actively engaged in assembling isolated data bits into contextually-derived, comprehensive, and comprehensible ensembles. Building the patient’s story is facilitated through the use of a chronologically-organized textual narrative (i.e. free-text notations) structure and structures that promote visual bundles of clinical data. The use of an EHR can problematize clinicians’ ability to build the patient’s story and to disseminate it with other members of the care team when data interconnections are fragmented. Fragmentation happens when narrative spaces are dispersed and/or character-limited, and when data displays are not chronologically organized in visual assemblies. The constraint of chronologically and contextually isolated data inhibits clinicians’ ability to read the why and how interpretations of clinical activities from other team members. When an EHR splinters narrative reports, there is a loss of shared interprofessional understanding of the patient’s story, and time efficient care delivery can be compromised.

Medical Research: What should clinicians and patients take away from your report?

Drs. Varpio and Rashotte: Clinicians need the opportunity to build the patient’s story. EHR vendors can support building the patient’s story by designing interfaces that present data as chronological interconnections and preserving clinician narratives as wholes (not dispersed sentences). Healthcare administrators can support the need for unrestricted use of free-text notations in an EHR system despite their goal for elimination of redundancy in charting. Healthcare educators can explicitly focus on connectivity education, such as bundle-making and narrative-building skills.

Medical Research: What recommendations do you have for future research as a result of this study?

Drs. Varpio and Rashotte: Give clinicians the ability to format data input and display options. Visual and narrative “wholes” are more informative than disconnected data “bits”. Further research is needed to help answer the question: How do we go about supporting the process of creating connectivity for the enhancement of clinical reasoning and ICP through the use of  EHR systems?


The EHR and Building the Patient’s Story: A Qualitative Investigation of How EHR Use Obstructs a Vital Clinical Activity

Varpio, Lara et al. International Journal of Medical Informatics
Online: September 14, 2015
DOI: http://dx.doi.org/10.1016/j.ijmedinf.2015.09.004

[wysija_form id=”5″]

Lara Varpio, PhD and Dr. Judy Rashotte PhD (2015). Electronic Medical Records Make It Harder to Understand the Patient’s Story 

Last Updated on September 24, 2015 by Marie Benz MD FAAD