To me, what she points out to be the problems, if they are what she sees as the major problems, seem fairly minor. One of the problems was the limitation the system puts on the number of characters they physician can input into an assessment field. This problem, from a programmer's point of view is not a difficult one. Viewed from a higher view, it is a matter of altering parts of the program and changing the allowed character numbers to one that is determined to be sufficient. It shouldn't be a major problem from a storage point of view either, as plain text doesn't take up much storage space. Of course, there could be other reasons behind the initial design and decision to make the limit of 1,000 characters. Still, this is a simple issue that can be resolved by a better communication with the physicians/management and software developers/management.
The second "glitch" Dr. Ofri points out is:
...Nobody, for example, leafs through a chart anymore, strolling back in time to see what has happened to the patient over many years. In the computer, all visits look the same from the outside, so it is impossible to tell which were thorough visits with extensive evaluation and which were only brief visits for medication refills. In practice, most doctors end up opening only the last two or three visits; everything before that is effectively consigned to the electronic dust heap.
The root of this discomfort is also, I think, similar to the first problem. It could be simply a matter of the physician being resistant to change (for, people are almost always unappreciative of changes to any part of a frequently visited web site or blog, even if that means the new design will have a better functionality, let alone a change from a paper-based work that has been in place for decades to a computer based one).
If resistance to change is really not the major problem, then the issue can be easily resolved or improved, again, with more (or better) communication among the users and the designers of the programs. It seems to me just a matter of enhancing the interface of the program to make it visually easier for the physician to see what Dr. Ofri would like to see -- make a color based button for each visit on the top right hand corner of the window to show if this visit were extensive or brief, etc. In fact, I see a better outcome from such design than the paper-based record. For example, assuming that an extensive visit in the traditional visit meant that there were more paper work for that particular day than others, the major visual indicator of the type of visit would have been the size of the pile of papers. On the other hand, adding a brief/extensive visit field to indicate the type of visit in the electronic system would make it easier to visualize and access. More helpful detail would be made easily accessible through the EMR than would have been through the traditional paper-based record system.
