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our first Mac or PC. This invention, along with the development of the lnternet, and the laptop a few years later, led to the present era of distributive computing and geographic freedom from the mainframe: the computer now came to you.
My familiarity with computing and belief that it would
be important in health care led, as hospital information systems began to be developed, to my joining a small number of faculty members who had an interest in the application of computers to medical practice. Most of them knew a lot more about computing than I did, but I had some insight into what came to be known as the human- computer interface and was able to articulate what would be important to me as a clinician using a computer. Our little group had a strong belief that clinicians using the computer were the customers, and tried to make clear what we thought the customer’s needs were. This became critically important during the development of CareWeb, the University of Michigan Hospital’s homegrown electronic health record, which came on line in the mid-1990’s. The great advantage of CareWeb was that it was home grown: clinicians had direct input into its look and feel, what it would do and how it would be used. At that time, I was also doing chart reviews in dozens of hospitals making quality of care determinations for the Professional Standards Review Organization program, which oversaw Medicare and Medicaid. Doing this, I got a lot of experience in what the interface between medical documentation and quality oversight – an early form, if you will, of “meaningful use.”
By the late 1990’s, the paper medical record, along with all the many work habits associated with it that had developed over decades, was on its last legs. The amount of information going into the medical record was expanding exponentially as patients got sicker and care more sophisticated. The paper records that were being transported, stored and pulled up for clinic visits had become gigantic and unwieldy. Putting some records on Microfiche helped a little, but was insufficient and expensive. The medical record had
to be computerized.
The challenge, as more and more of the work that had
theretofore been done on paper was transferred onto electronic media, was how to maintain the medical record as an effective means of communication among physicians, nurses and all others involved in a patient’s care – how to preserve the habits of good documenta- tion while dispensing with the tedious, time-consuming aspects of electronic data entry, storage, and retrieval.
The primary purpose of the written medical record was, is, and has always been, to record patient care (or “document” it in current terminology) in a way that enables caregivers to both provide good care and also learn from one another. As a result of my years doing medical quality oversight, I had my own ideas about what was most meaningful in the chart, at least to someone who was reviewing the chart for quality and meaningfulness of care. I knew what made a progress
Volume 69 • Number 2 Washtenaw County Medical Society BULLETIN 9

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