The Illegible Medical Record: Are EHRs Helping?

Electronic health records help solve some problems, but they aren’t the panacea needed to clear up illegible chart notes sent to pharmacies.

By Linda M. Girgis, MD, FAAFP

For decades, people have made jokes about doctor’s handwriting, which is notorious for being illegible. It is no laughing matter, however. In fact, it can be very dangerous as illegible notes can lead to misinterpretation and misunderstandings, including wrong medications being dispensed at pharmacies.

Then came the arrival of electronic health records (EHRs)

Now, not only are doctor’s able to have an electronic record available at their fingertips, they can also transmit prescriptions directly to pharmacies. No more looking for lost charts, and no more call backs from pharmacists because they can’t read the doctor’s prescription.

EHRs Don’t Solve The Illegible Chart Problem
In spite of the benefits EHRs offer in trying to remedy the problem of illegible chart notes, they still come up short for several reasons.

1. The transmission of electronic prescriptions often times they are simply lost in cyberspace. Instead of having a prescription the pharmacist can’t read, there is simply no prescription at all. I receive too many phone calls to count from pharmacists or patients telling me I never sent the prescription to the pharmacy despite the fact I have a confirmation it was indeed received. In fact, I get more calls about missing prescriptions than I ever did for prescriptions the pharmacist was unable to read.
2. I sometimes write a prescription that lacks directions when it arrives at to the pharmacy despite those directions being in the EHR. This results in call backs, negating the one major advantage e-prescribing offers.
3.  All EHR systems are different. They all have their medication list and diagnoses list in different places of the chart making it hard to look this information up quickly when you using another system.
4. With the way current systems are built, the goal is capturing bullet points to help with billing and coding. This often results in too many details being included in the chart that are not essential to patient care. Yet, it needs to be included to be paid correctly and to meet the requirements for meaningful use. It takes just as long deciphering all this data as it does to try to translate poorly handwritten charts.
5. EHRs offer the advantage of not being physically misplaced. However, when the system goes down, you have no EHR. This very thing happened to me recently when our software vendor had a system-wide problem resulting in users being unable to log in. As a result, we did not have access to their medications or problem lists and were unable to send prescriptions electronically. While a misplaced chart can be frustrating, having your whole system down for days is downright dangerous.

All is not gloom and doom as far as the EHR is concerned. As I try to read over hundreds of handwritten notes from other doctors I find myself grateful for the advent of them. But as a replacement for handwritten prescription, there is still much work to be done.

About The Author
Linda Girgis, MD, FAAFP, is a board certified family doctor with Girgis Family Practice. Dr. Girgis studied medicine at St. George's University School of Medicine and served her residency at Sacred Heart Hospital in Allentown, PA.