Electronic Medical Systems

  • Gail Berkenblit
  • Elizabeth Koehler
  • Jeremy EpsteinEmail author


The use of EMRs is now widespread. The adoption of electronic medical records has changed the practice of clinical care and requires training of residents in effective use, while many faculty are still struggling to optimize theirs. The EMR allows the development of new note formats but also raises pitfalls of copy forwarding and note bloat. The EMR can be a useful tool or a distraction during patient-physician interaction, and best practices are evolving around exam room usage. The EMR also serves as a means of communication between the team and work flows around lab results, and patient communication must be established. Finally, the EMR can enhance population health and be a tool for panel management. This chapter focuses on teaching and evaluating resident practice in these skills.


Electronic medical record, EMR Patient-physician communication Dashboards Performance measures 


  1. 1.
    Henry J, Pylypchuk Y, Searcy T, Patel V. Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015 [Internet]. The Office of the National Coordinator for Health Information Technology; 2016 May [cited 2016 Oct 28]. (ONC Data Brief). Report No.: 35.
  2. 2.
    Jamoom E, Yang N, Hing E. Adoption of Certified Electronic Health Record Systems and Electronic Information Sharing in Physician Offices: United States, 2013 and 2014 [Internet]. National Center for Health Statistics; 2016 Jan [cited 2016 Oct 28]. (NCHS Data Brief). Report No.: 236.
  3. 3.
    Esch LM, Bird A-N, Oyler JL, Wei Lee W, Shah SD, Pincavage AT. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns. Med Educ Online [Internet]. 2015;20:29702. [Cited 2016 Oct 27]. CrossRefGoogle Scholar
  4. 4.
    Weed LL. Medical records that guide and teach. N Engl J Med. 1968;278(11):593–600.CrossRefPubMedGoogle Scholar
  5. 5.
    Weed LL. Medical records that guide and teach. N Engl J Med. 1968;278(12):652–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Brown PJ, Marquard JL, Amster B, Romoser M, Friderici J, Goff S, et al. What do physicians read (and ignore) in electronic progress notes? Appl Clin Inform. 2014;5(2):430–44.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Clarke MA, Steege LM, Moore JL, Koopman RJ, Belden JL, Kim MS. Determining primary care physician information needs to inform ambulatory visit note display. Appl Clin Inform. 2014;5(1):169–90.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Koopman RJ, Steege LMB, Moore JL, Clarke MA, Canfield SM, Kim MS, et al. Physician information needs and electronic health records (EHRs): time to reengineer the clinic note. J Am Board Fam Med. 2015;28(3):316–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Stetson PD, Bakken S, Wrenn JO, Siegler EL. Assessing electronic note quality using the physician documentation quality instrument (PDQI-9). Appl Clin Inform. 2012;3(2):164–74.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Burke HB, Hoang A, Becher D, Fontelo P, Liu F, Stephens M, et al. QNOTE: an instrument for measuring the quality of EHR clinical notes. J Am Med Inform Assoc. 2014;21(5):910–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lin C-T, McKenzie M, Pell J, Caplan L. Health care provider satisfaction with a new electronic progress note format: SOAP vs APSO format. JAMA Intern Med. 2013;173(2):160–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Hirschtick RE. A piece of my mind. Copy-and-paste. JAMA. 2006;295(20):2335–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Nuovo J, Hutchinson D, Balsbaugh T, Keenan C. Establishing electronic health record competency testing for first-year residents. J Grad Med Educ. 2013;5(4):658–61.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Stephens MB, Gimbel RW, Pangaro L. Commentary: the RIME/EMR scheme: an educational approach to clinical documentation in electronic medical records. Acad Med. 2011;86(1):11–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Taft T, Lenert L, Sakaguchi F, Stoddard G, Milne C. Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study. J Am Med Inform Assoc. 2015;22(1):192–8.PubMedGoogle Scholar
  16. 16.
    Verghese A. Culture shock—patient as icon, icon as patient. N Engl J Med. 2008;359(26):2748–51.CrossRefPubMedGoogle Scholar
  17. 17.
    ACGME Program Requirements for Graduate Medical Education in Internal Medicine [Internet]. Accreditation Council for Graduate Medical Education; 2016 July [cited 2016 Oct 28].
  18. 18.
    Roberts DH, Gilmartin GS, Neeman N, Schulze JE, Cannistraro S, Ngo LH, et al. Design and measurement of quality improvement indicators in ambulatory pulmonary care: creating a “culture of quality” in an academic pulmonary division. Chest. 2009;136(4):1134–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Kimura J, DaSilva K, Marshall R. Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures. Dis Manag. 2008;11(1):13–22.CrossRefPubMedGoogle Scholar
  20. 20.
    Koopman RJ, Kochendorfer KM, Moore JL, Mehr DR, Wakefield DS, Yadamsuren B, et al. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med. 2011;9(5):398–405.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203.CrossRefPubMedGoogle Scholar
  22. 22.
    Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104–12.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Agency for Healthcare Research and Quality. Comprehensive Unit-based Safety Program (CUSP) [Internet]. 2016 [cited 2017 Feb 22].

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Gail Berkenblit
    • 1
  • Elizabeth Koehler
    • 2
  • Jeremy Epstein
    • 1
    Email author
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Stanford UniversityStanfordUSA

Personalised recommendations