Confusion about EHRs - It's Only Natural

September 19, 2011
Daniel Essin, MA, MD

There are a couple of facets of human nature that have a big impact on how people perceive EHRs and what they do, or don't do, with them.

There are a couple of facets of human nature that have a big impact on how people perceive EHRs and what they do, or don't do, with them. One is that there are some things that we think we grasp (whether we do or not is another matter) and as a result we're pretty comfortable with them. There are other things that seem like they will be impossible to understand so we assign them to the category of the really hard, mysterious, overwhelming and frightening stuff and try to avoid thinking about them. You know this category. This is where people throw up their hands and say “That's way beyond me” or “I'm just no good with [fill_in_the_blank].”

When we think we grasp something, we run headlong into our old friend, the normal distribution. If you remember, when a characteristic is normally distributed, 68 percent of the occurrences fall within ± 1 standard deviations of the mean. Everyone understands this at some level except when it comes to themselves. According to Allstate Insurance, drivers believe their own driving ability is well above that of other drivers on the road. Nearly 64 percent (perhaps the middle two-thirds) of American drivers rate themselves as "excellent" or "very good" drivers. Statistics tell us that only about 2.5 percent of the population can be the ones that are really excellent.

So when we think we grasp something, that gives us the self-confidence to think that we know more then we really do. The converse is also true, when we don't feel that we grasp a subject we assume not only that we don't know very much about it but that it is so complicated that it is ungraspable by mere mortals like ourselves and that it takes a really special person or organization endowed with special talent and knowledge.

Things that are big and complicated have got to be expensive - right?

And there you have it. When you first accomplish something, whether it's riding a bike or transferring a digital photo to your PC and making a print, you're excited. The whole thing seems within your grasp. You're at a point where you don't yet know what you don't know and you're bursting at the seams to tell everyone and get them on board with this great new capability. We've all run into the PC evangelist - they've just made something work on their computer and they are busy telling everyone to get that software or gadget or whatever.

EHRs are neither as simple as the computer evangelist thinks they are nor anywhere near as complicated as most people assume they must be - and remember - any computer application that lets you get your clinical work done and leaves behind a medical record (regardless of its form or any of the gory details) is, in some sense an EHR and don't let anyone tell you otherwise. It may not be perfect, and it may not meet some arbitrary set of criteria, but if it's a medical record and it’s electronic, then it’s an EHR.

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