Quality assessment is “limited” via EMR. No one reads a chart at the VA anymore in the quality assessment word. All they do is electronic searches that often/usually fail to find the appropriate information. We get no credit for writting 1000 words documenting every milimeter of a diabetics foot if we dont use the clinical reminder. Thus what usually gets evaluated is quality of documentation and not quality of care.

#2 if a note is unsigned it cant be seen. Residents have to have their notes cosigned by an attending. Until that happens no one can use that note to care for the patient. this happens alot!

#3 The patient only has one record now. That seems like this would be a good thing and it is except from a quality assessment standpoint. I often get “dinged” for BP control when the BP was fine when I saw the patient but when they go to another clinic a week later and its high i get nailed for it. Under a paper chart system I would be fine.

#4 Lack of thinking- I truly believe EMRs lead to less doctor thinking. Everything is a template and you dont have to think as much as when you had to hand write the note. Its easy to keep bringing the same ideas forward via the template or cutting/pasting.

#5 the EMR has likely greatly changed the doctor-patient relationship. More doctors now look at the computer and type and not pay attention to the patient. I suspect very few docs wrote their handwritten note while interviewing the patient. But now many type away while the patient talks. I consistently hear this from patients.

There are other problems but I think these are important. I look forward to other’s comments