"The tragedy of the electronic health record".

The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient. —Francis W. Peabody 1 T he Winter 2015 issue of The Pharos featured an article titled, " The Electronic Health Record: Are We the Tools of Our Tools? " by K. Patrick Ober and William B. Applegate (pp. 8–14). In it, the authors described their institution's and physicians' experiences with electronic health record (EHR) systems, discussed the general state of EHRs and how they are used today, related the problems they have experienced with EHRs, and made recommendations for changing how we use them to reestablish the primacy of the doctor-patient relationship. Their article hit a nerve. We and the authors received many comments on the article, two of which can be seen in Letters to the Editor on page 43. They were, as one might predict, almost uniformly in agreement that EHRs fall far short of what physician and patients need. My own first experience with EHRs was in the 1990s in a university ambulatory care internal medicine practice. I looked forward to the coming implementation with anticipation , since I felt that EHRs would improve patient care, leading to more efficiency and safety. I was disappointed, as many of us were. Twenty years later, we are still disappointed. It is important to emphasize that medical records have existed since the beginning of the profession of medicine. Some of the first medical case histories frequently used in teaching were written by Hippocrates in the fifth century BC. The clinical medical record appeared in the nineteenth century in Europe in major teaching hospitals, and was soon adopted in the United States. The modern medical record was developed in the twentieth century—data about each patient, including clinical data, was recorded, organized, often in a standardized format, and stored. 2 Improvements in medical records continued during and after World War II in step with advances and progress in medicine. Complete and accurate medical records enabled physician and institutions to better care for and treat patients and improve the safety and quality …