Dr. Scot Silverstein travels the country attending conferences, speaking on panels and voicing concerns about health care's headlong rush into a reliance on electronic medical record systems.

"Older and younger physicians alike are increasingly concerned about the poor design and poor usability of clinical IT," Silverstein said.

The Drexel University College of Information Science and Technology faculty member calls "EMR" an anachronistic term from a time when the systems were merely storage tools for records.

"What is meant in 2012 is not just an innocuous 'filing cabinet,' but an enterprise clinical resource management and workflow control system -- not just storing records, but regulating and governing all clinical behavior and action," Silverstein said.

Silverstein contends such systems are inappropriate for some health-care environments, such as emergency rooms and intensive-care units.

"They slow down and distract clinicians due to their generally poor user interfaces, in the worst possible setting, and disrupt clinician cognition," he said.

Silverstein defines such cognition as the decision making and problem solving necessary to provide quality health care.

Kay Takes, vice president of patient care services at Mercy Medical Center-Dubuque, said the hospital finds electronic medical records a help in the critical environment of the ICU.

"Specifically in the ICU, in the last 13 months we've gotten enhancements that allow us to download values from the medical equipment -- it's automatically pulled into the medical record," she said "It's been fantastic. The availability of the information is enormously valuable. It's been a lot more of a benefit than a hindrance."

Silverstein thinks current clinical IT programs focus too much on raw data and not enough on supporting a physician's decision-making abilities.

"As a result, valuable time and energy is spent managing data as opposed to understanding the patient," he said. "Ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models that depict the health status of the patient, including information on how different organ systems are interacting, epidemiological insight into the local prevalence of disease and potential patient-specific treatment regimens."

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