The misinformation era: the fall of the medical record.

Medical record information has become less reliable than ever before despite the electronic information revolution in medical care and the authority medical records have been accorded in our society. Long flawed by errors introduced by medical personnel, patients, and machines, medical records have had a further decline in credibility as a result of the loss of confidentiality and the imposition of well-meaning but unrealistic cost-control regulations on medical practice. Medical records are being distorted and fashioned to keep clinically important but sensitive personal information about patients from public view. To comply with standards of care and a reimbursement system blind to biologic diversity, medical records are being forced to address only the technical side of care. Until these deficiencies are corrected, our increasing dependence on medical records should be balanced by increasing skepticism about the value of the information they contain.

[1]  J. Butterworth,et al.  Auscultatory Acumen in the General Medical Population , 1960 .

[2]  L. McMahon,et al.  Can Medicare prospective payment survive the ICD-9-CM disease classification system? , 1986, Annals of internal medicine.

[3]  J. Yerushalmy,et al.  An evaluation of the role of serial chest roentgenograms in estimating the progress of disease in patients with pulmonary tuberculosis. , 1951, American review of tuberculosis.

[4]  L. Goldman,et al.  Patient-physician concordance in problem identification in the primary care setting. , 1980, Annals of internal medicine.

[5]  J. Mamlin,et al.  Ambulatory medical care quality. Determination by diagnostic outcome. , 1974, JAMA.

[6]  D. Brody Physician recognition of behavioral, psychological, and social aspects of medical care. , 1980, Archives of internal medicine.

[7]  L. Koran,et al.  The reliability of clinical methods, data and judgments (second of two parts). , 1975, The New England journal of medicine.

[8]  R. Stewart,et al.  Drug-induced illness leading to hospitalization. , 1974, JAMA.

[9]  C J Schramm,et al.  Interhospital differences in severity of illness. Problems for prospective payment based on diagnosis-related groups (DRGs). , 1985, The New England journal of medicine.

[10]  P. Greenland,et al.  Selection and interpretation of diagnostic tests and procedures. Principles and applications. , 1981, Annals of internal medicine.

[11]  S. Cohen,et al.  The usefulness of preoperative laboratory screening. , 1985, JAMA.

[12]  S. Wartman,et al.  The effectiveness of routine screening questions in the detection of alcoholism. , 1988, JAMA.