A new study argues that some doctors make only minimal use of electronic health records (EHRs) not because they’re Luddites, but because their style of practice “absorbs” clinical uncertainty rather than trying to minimize it through the use of IT. If this is true, the widespread adoption of EHRs may not change how some doctors diagnose and treat patients.
The study, which was published in the Journal of the American Medical Informatics Association (JAMIA), used interviews and direct observations of 28 physicians in a Texas multispecialty group to explore the reasons why some doctors used the practice’s EHR more than others did. The researchers showed that the physicians’ perceptions of uncertainty in caring for their patients were correlated with how they used the EHR.
For the uninitiated, uncertainty is a universal attribute of medical practice, not a sign of an incompetent clinician. Good evidence supports less than half of what doctors do, and there are many clinical situations in which they don’t know what they’re confronting or, even if they do, what they should do about it.
Based on their observations and interviews, the researchers divided the Texas doctors into three categories: reductionists, who believed that the more structured data they recorded in the EHR, the less uncertainty they had and the better the care they were providing; absorbers of uncertainty, who spent more time conversing with patients and less time documenting information; and hybrids, who exhibited characteristics of both reductionists and absorbers.
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Date: May 28, 2013