Does EMR depersonalize medicine?

The NY Times published a very good op-ed by a Columbia pediatrician today:

http://www.nytimes.com/2009/03/06/opinion/06coben.html?ref=opinion

The author's concern is that instead of actively engaging with patients, as she did with paper charts, she is now forced to stare at a computer during visits, and conduct her history-taking in a pre-specified order determined by an EMR program. This is a real weakness of EMRs - not one that cannot be overcome, but one that many people (myself included) have not considered much.

While simply putting records online is helpful, there is a huge value in having very structured EMRs. The information doctors write in free text areas is very difficult to collect and query, unless you use natural language recognition programs. These are unreliable, though they may get better. So if you want to track diagnoses for public health reasons, measure performance of doctors, or judge the quality of care patients get, you need to have the information in a specific place. Having the BP in the vital signs section and the diagnosis of hypertension in the flow chart/problem list makes it easy to track. Having it buried in a free text note does not.

I hope that funding for EMRs will create a robust marketplace in which the best designed products thrive. Many users may focus on more obvious features of EMRs, (connectivity, decision support, etc) as well as cost, and not realize that some interfaces are better than others at allowing them to conduct their patient visit in a more flexible, personalized way.

As we rush to roll out EMRs, and invest in systems that may be in place for years to decades, it is worth considering the actual end-user experience.