John W. Beasley, MD; Christine A. Sinsky, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2589.
Beasley JW, Sinsky CA. Electronic Health Records. Ann Intern Med. 2014;161:680. doi: 10.7326/L14-5021-6
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Published: Ann Intern Med. 2014;161(9):680.
We appreciate the comments on our essay and join Dr. Miller in wishing that we had written it 10 years ago. Electronic health records were designed and implemented without a fundamental understanding of the real needs of primary care clinicians and staff or any systematic attempt to evaluate the effect on patients or caregivers. An analogy between implementing EHRs without understanding the needs of clinicians or potential hazards and introducing a new medication without understanding the cellular biology of patients or attempting postmarketing surveillance on effectiveness or adverse effects can be made.
To understand the “basic science” of primary care and evaluate the effect of EHRs (some of which may be subtle and relate to such factors as break-in tasks), input from physicians alone will not be sufficient and outside expertise is needed. One attempt to do this is our collaboration between industrial and systems engineers and primary care clinicians (www.fammed.wisc.edu/i-practise).
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