The NICU Electronic Medical Record and Performance Evaluation

Abstract

An electronic medical record (EMR) is a cognitive tool with a determinative role on our work and results, and therefore contributes to unwarranted practice variation. Current NICU EMRs generally are underconceptualized, particularly in the sense that they do not make explicit much of the tacit thinking we employ in doing our work. In contrast, an EMR database most usefully maps and stores explicit data elements—in distinction to free-text fields, which generally permit variable, inconsistent, incomplete, and even potentially inaccurate, characterization of the circumstances one is trying to record. Additionally, free-text fields generally preclude reliable and unbiased automated data retrieval at the group level. Many NICUs use an EMR produced by one of a few vendors. However, that does not assure NICUs use the same data elements nor share a common conceptualization of their work, including (at least, implicit) EMR aims. Understanding the notions of elementary questions, the difference between data, information, knowledge, and wisdom, and setting explicit goals for a NICU EMR increases its value as a cognitive tool. NICU EMR goals should include features not feasible without an EMR, such as computing posttest disease probability, decreased risk of error, and improved provider communication efficiency. User acceptance of an EMR does not necessarily imply a problem was successfully solved.