Digital records are valuable for health in several cases, for example, when the patient needs or wants all their records.

OK, but you need to clarify your statement. As you said,

>>> note taking and documentation is required by law.

So then, the EMR not a value add, which is also what I wrote. It just so happens that in the US the primary reason is to get paid, and its also why some doctors still eke out a living without an EMR (but still with some kind of paper medical files)

Do EMRs improve the standard of care?

Big time.

In some cases where hospitals do paper charting, it can be mis charted.

or, there can be issues with not recording medication as being given or not, and the patient can miss their dose because a nurse thinks it was given. There is some cases where such confusion is tolerated depending on the patient.

>>> or, there can be issues with not recording medication as being given or not, and the patient can miss their dose because a nurse thinks it was given.

Partially true. First, there's no need to record anything in any EMR, this is a big misunderstanding. The act of sending the script is recording it itself. There's no need to do data entry in EMR.

You can test this by simply attempting to send eScripts outside of the EMR. PBM systems like surescripts will alert the provider as he's prescribing in any other 3rd party system of any problems (multiple scripts of same meds, reactions, etc).

Even a paper script needs to be adjudicated via PBM by the pharmacy, which means there's a PBM record already the moment that script is created and picked up. That's how most doctors and pharmacies know whether pts are picking up their meds.

Now if a doctor is fully on paper based then you do have a problem because there's no feedback to a paper record IF the doctor is failing to log into the PBM system to check for drugs dispensed. In this case, the EMR may appear superior on this front, but it also introduces its own set of problems, such as a very common one - patients missing their scripts because the pharmacy is out of meds, causing multiple scripts being sent and back and forths with busy doctors. This is never a problem with a paper script.

Perhaps one of the very few value adds is turning the MD scribble into something legible, but that's something that can easily be solved without any click, or an EMR in the middle .

> First, there's no need to record anything in any EMR, this is a big misunderstanding. The act of sending the script is recording it itself. There's no need to do data entry in EMR.

Not quite. Hospital EMRs now have barcoding and scanning, for timed doses being delivered an to make sure they were - saw it first hand in the past year.

This is a shadow working culture issue, not a technical one.

Hospital workplace cultures can be quite toxic, and that plays out varying degrees of horrible for certain segments of the population 60 percent of the time, every time.

In hospitals, prescriptions are administered usually by a nurse.

Since it's a problem that can be casually looked away from because it doesn't impact one group, it can be downplayed.

Absolutely. They can allow providers to easily track their adherence to Patient Quality measures which directly affects their income.

The question is whether they improve the standard of care.

Quality measures produce numbers so bean-counters are satisfied at CMS.

For example: Before i was not submitting any quality measures, but my patient satisfaction was sky high, and i had the lowest complications for years.

Now i report quality measures, but as a result of documentation requisites and reporting requirements, i have less time to see patients , and therefore make more mistakes.

My quality measures are good because I'm talking to patients about quitting smoking and getting leaner - but i was already doing that previously. Now objectively, since I now have less time due to EMR requisites, my patients are worse off than before and it shows with slightly more complications my patient's aren't as happy as their waiting times are longer (and getting worse too).