The Prairie Doc Perspective Richard P. Holm M.D. Perspective 1-2-13

Posted January 1, 2013 at 8:00 am

Computers, health care, and the future

The computer age has finally come upon the practice of medicine.

While the rest of the world has been living with electronic checkout, accounting, and business applications for quite a while, medicine has somehow escaped the plug-in paperless chart…until now.

Why has the computer been so delayed in entering into the hospital rooms and private offices of medicine? Maybe it’s because of the complexity of medicine; the potential risk to patient confidentiality; the time and cost required for physicians to learn a new system; or maybe it’s because of the stubborn nature of physicians. There are a lot of possible reasons why the computer came late to medicine, but why did it finally come around?

In recent years as physicians’ practices have been brought together into larger groups, electronic-portable-sharable records have become more inviting. Additionally the Government is strongly encouraging the electronic medical record (or EMR) by actually providing higher Medicare payments to doctors who are effectively using an EMR. The Government is motivated by the belief that EMRs will reduce medical errors, enhance medical research, and set the stage for controlling run-away health care costs.

Indeed there are more reasons an EMR could improve care: it gives immediate access to patient records, (old way pulls old paper charts from large file rooms;) allows for readability of record, (old way forces trying to interpret the doctor’s writing;) and provides for portability of record when patient moves, (old way copies reams of pages and mails them in bulk.)

But different electronic record systems don’t speak to each other; the majority of systems are generated by computer geeks not physicians; and every EMR system seems more written for billing and legal defense rather than made to enhance communication to help solve the patient’s problems.

But probably the biggest problem for the EMR comes from using checklists instead of writing out the patient’s narrative. The computer puts us at risk of losing the valuable essence of the patient’s story.

Over time I expect EMR systems will merge, improve, and care providers eventually will learn to use this tool. But it is still just an instrument to enhance, not replace or interfere with the important interface between patient and doctor.

The computer is here and we need to make it work.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central. Visit

The Prairie Doc Perspective Richard P. Holm M.D.