The argument that each visit is unique is not an argument for chaos in the organization of our visits and record – the visits need to be organized and recorded in a standard fashion. It is, rather, recognition that patients typically present with atypical symptoms and that all patients and visits are different from one another. To provide excellent medical care requires that well-trained clinicians make choices about what should be addressed at any given visit and that our charts and electronic record systems must be driven by patient needs and outcomes, not checkboxes derived from potential needs that are divorced from common sense for the visit at hand.
As we reflect further on this issue, we have come to the conclusion that the difference between our EHR systems and Aunt Tillie is that, when Thanksgiving came, we could avoid Aunt Tillie.
Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.