I find the nurse's comments on the design issues of the EHR both fascinating and too familiar.
As an ambulatory-care nurse and administrator for the past 25 years, these very same issues have existed and continue to exist to date with paper and electronic records. We have created template after template, flow sheet after flow sheet, to enable the physicians to document appropriately for the past 25 years that I am aware of and yet we continue to have the exact same issues. The only issue we have really eliminated with the EHR is legibility.
Physicians need ongoing training in evaluation and management documentation in order to meet regulatory standards in terms of coding and reimbursement. Whether you have an electronic record or a paper chart, the issue does not go away. You can develop problem lists, flow sheets, et al., until you are blue in the face and even broke to help get the information necessary for every visit documented. Until you either have developed a paper or electronic norm template with all systems, diagnoses, medications, health education/anticipatory guidance and history included, and the physician can dictateusing voice technologyto it by addressing the abnormal only, the industry will continue to spend millions of dollars on electronic solutions that the physicians will never use effectively.