Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era

This follow-on article moves the discussion forward by adding further dimension to the issue of unintended consequences from the perspective of the United States health system.

Unintended Consequence 5: Data Obfuscation

Physicians frequently create their clinical notes by using the patient's previous note, a practice known as copy-and-paste. As a result, they often produce (and later deal with) uninformative, bloated notes that often contain redundant information and errors. In addition, these notes do not provide the data in a way that increases clinicians' situational awareness (ie, the perception and comprehension of relevant information necessary to take action), and in some cases may never be read. The problem is aggravated by overwhelming CDS alerts and reminders; many clinicians complain that such alerts make them vulnerable to information overload, which might lead them to miss important information. The obfuscation of relevant data resulting from bloated records has been reported, associated with potential safety hazards and with delayed or incorrect decisions at the point of care.