Evolutionary Pressures on the Electronic Health Record: Caring for Complexity.

Frances Peabody’s timeless lecture toHarvardMedical School students, published in JAMA almost90years ago,1 spoke of the complex and deeply human experience of illness, as epitomized by the powerful observation “for the secret of the care of the patient is in caring for the patient.” Peabodyemphasizedhowcaringmeantunderstanding for each patient how particular personal and emotional circumstances influencedhis or her health. Today, clinicians encounter a level of complexity—co-occurring chronic and rare diseases, organ transplantation, artificial devices—that has completely altered the practice of medicine,while thepersonalexperienceof illnessandthe social context are as important as ever. Escalating clinical complexity has increased thedependence on technology for diagnosis, illnessmonitoring, and treatment, andmostphysiciansexperience this dependence daily in interactions with the electronic health record (EHR). The EHR hasmany virtues: It supportsarduousandtime-intensive taskssuchasorderentry and medical history review, and most systems routinely alert clinicians if they prescribe medication