The electronic medical record: optimizing human not computer capabilities

The widespread adoption of computerized medical records provides medical administrators and payers the means to promote more standardized and thorough medical records by insuring clinicians complete mandatory screens, history and physical templates, and formatted treatment plans. But there is a dearth of evidence that such measures, whether computerized or not, improve clinical outcomes and reason to suspect that they may impede care. While these measures maximize the computer's capabilities they are insensitive to human capabilities. A series of 'check-offs', 'fill-ins' and 'drop-downs' might facilitate quality assurance activities, but such standardized measures can interfere with the clinicians' processing of information into narrative structures that are necessary for memory and decision making. Computerization does not necessitate this standardization. The adoption of an electronic medical record could provide the opportunity to move beyond standardized measures that were developed to oversee written records and instead harness the computers' capabilities to promote the unique, specific, and narrative quality of the clinical encounter.