Lessons for electronic medical records from family medical practices

Motivated by the push towards the adoption of electronic medical record (EMR) systems, we conducted a series of observations, interviews, and patient record audits at four family medical practices to investigate the nature of record keeping in diagnostic testing processes. One lauded benefit of EMR is to reduce the number of steps required to process test results and reduce the number of errors. We found this to be the case. However, in offices with paper records, we found many instances where people helped create safety by correcting errors made at previous stages due to naturally occurring feedback loops that allowed for compensation. The EMR office faced unique challenges in this regard because of impoverished communication and feedback loops, both from the EMR system and support staff. It is important to appreciate the safety dynamics of paper based systems in the design of EMR systems and consider incorporating dynamics such as checks and redundancies into them.