In half the records, there was at least one thing the two doctors independently concluded should have been in the patient's record.
The researchers did another experiment where they assumed that the EMR, which happened to be in use in British Columbia, could capture more of the narrative with some extra engineering.
The cardiologists still found a severe problem in one out of four records, Resnik says.
Another issue with EMRs is the advance of medical science. In the early 1990s, a higher-resolution CT scanner was introduced. Radiologists started discovering semi-opaque nodules in the lungs which indicated a much higher probability of lung cancer. But older medical records simply offered the choice of "opaque" or "transparent" and had no way of expressing the newer notion of "semi-opaque."
Such examples must abound in medicine as it advances. How valuable will today's EMRs be in tomorrow's realities?
The traditional clinical narrative also has another set of nuances not present in the typical modern EMR. Narratives may say that something is "suggestive of" a particular condition without that condition actually being present. Patients may deny the presence of a particular condition, such as chest pain, but the EMR may not allow for such a denial to be a structured part of the record. In another example, doctors may agree that a particular pilot-as-patient should not be recertified to fly without undergoing a particular procedure.