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In Reply: As Drs Yackel and Embi point out, some of the problems with physician notes antedated the EMR, although these problems have certainly been amplified by the repetition that EMR engenders. While the remedy for redundant, ineffective EMR notes will indeed be difficult, the assertion of the authors that the problem itself is complex is not necessarily correct. The problem can be simply stated as follows: (1) physicians want to write notes that intelligently describe the clinical situation; (2) physicians want to write notes that are thorough and maximize reimbursement; (3) with the EMR, item number 2 can be done quickly but number 1 cannot; thus, (4) convoluted, duplicative notes are common while thoughtful, logical notes are not.

However, potential solutions are indeed complex or problematic: (1) human behavior will change and physicians will spend the time necessary to create original notes that are concise, well-organized, and logical; or . . . [Full Text of this Article]

Robert E. Hirschtick, MD
rober@northwestern.edu
Department of Medicine
Feinberg School of Medicine
Northwestern University
Chicago, Ill

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