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A downside of electronic health records: How 90 percent of Merced County, California patients became Albanian

A downside of electronic health records: How 90 percent of Merced County, California patients became Albanian

Electronic medical records have become an essential backdrop to modern medical practice. Paper charts, not long ago the mainstay of health-care documentation, have become antediluvian. Whereas once doctors used to write notes with pen and paper and insert the paper into a physical binder, doctors now keep track of patients by clicking keys on a keyboard and entering data into a computer software program.

One of the great advantages of the electronic medical record over its ancestral precursor ‘notes-in-a-binder’ is that records are now centralized and can be accessed by multiple authorized care providers, such that it is possible to know what treatment a patient received from any health-care provider working in the conjoined medical system, from primary care visits to hospital admissions. Physicians are less siloed within specialties and more able to share information.

This week’s Science section of the New York Times discusses the upsides and the downsides of modern technology in the medical workplace, but one of the downsides that isn’t emphasized is the fact that much of the data entered into electronic medical records is being mined to make important decisions about clinical care and health policy. And if data-mining is based on inaccurate information, then the whole operation is a house of cards. Let me cite one example.

A physician I know in Merced County, California has been practicing medicine for the greater part of three decades, and he was recently obliged by his medical group to transition from paper to electronic medical records. The medical-records software he uses mandates that he indicate on a pull-down menu the ethnicity of each of his patients. He views his patients’ ethnicity as non-essential to his practice, and so – pressed for time like most health-care providers – he clicks on “Albanian” for all of his patients, not because they are Albanian, but because “Albanian” is the very first item on the pull-down menu and therefore the fastest to access. The result is that over 90 percent of his patients appear to be Albanian, when in fact they represent the usual constituents of Merced County, with few if any Albanians among them.

Misinformation in electronic medical records, whether accidental or otherwise, has far-reaching consequences for patients and health care policy, because electronic medical records are being actively ‘data-mined’ by large health care conglomerates and the government as a basis for improving care. This is an important downside to consider as we move forward.

Previously: Health-care experts discuss opportunities and challenges of mining ‘big data’ in health care, Mining for research: How computerized records open new doors for medical researchers and More health-care providers embrace the high-tech office

Anna Lembke, MD, is an assistant professor of psychiatry and behavioral sciences at Stanford.

2 Responses to “ A downside of electronic health records: How 90 percent of Merced County, California patients became Albanian ”

  1. @JayM_HealthIT Says:

    Yes providers are strapped for time, but I know of no providers who really involve themselves with registering patients. That is the job of the front desk staff, and I’d say you’d be better off laying the blame at the feet of the staff rather than the IT system. (Garbage in, Garbage out, as they say)

    additionally, EMR systems soon will allow for patients to register themselves on-line via patient portals. These portals will be pervasive as they will be required by Meaningful Use Stage 2 requirements.

  2. Michael Melgar MD Says:

    Time is most certainly an issue here. Physicians have always been strapped for time but EMR’s rather than making us more efficient have added to this burden forcing physicians to make choices between taking the time to enter all the data perfectly or having the time to take care of patients properly. Unless these systems are improved you cant have both.

    I disagree with the comment above The IT system is a BIG part of the problem. These systems are not yet well designed. They are a work in progress. I am often forced to put a “not quite right” diagnosis down because the flawed search engine sometimes can’t find the diagnosis I am looking for even when its a common medical term. There is only so much time i can spend on this task.

    If the EHR were more efficient and user friendly the physician wouldn’t have to spend so much time on these tasks and wouldn’t be so pressured to enter “anything” just so he can move on and actually take care of the patients.

    Patient portals will help but not resolve this problem. Many patients are computer illiterate or have no access to computers or are not inclined to do anything until they are in the office at which point its too late. Also, while demographic information may be more accurate when the patients complete it themselves, clinical information is entirely physician driven and will not be affected in any positive way by the introduction of a patient portal.

    If you want more accurate information in the system make a system that is easier and more intuitive. It would be nice to be able to use these systems for research but the primary goal has to be the ability to allow physicians to provide better and more efficient care. In that regard these systems have had a net negative effect. When that gets fixed you will see more accurate data.


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