[bill_from_tampa]

I worked at the VA for over 2 decades, including the transition from handwritten to electronic notes. Wow. When I retired, the nursing notes for a patient visit were usually 2-3X longer than the docs note. The nursing note was entirely populated by templated text created by a hierarchy of supervisory staff tasked with satisfying all regulatory requirements. The poor nurses would ask the patient a series of prompted questions, click on the appropriate box, and a page of templated text would emerge. Actually finding useful actionable info in the nursing notes was impossible, or close to impossible. The docs began to demand, reasonably, that actual patient problems identified by the nurse be put in a specific area of the note rather than randomly scattered throughout 4-8 pages of templated text (which without this demand could be randomly intercalated with such useful info as "pt c/o chest pain when walking, much worse", found on page 5 of 8.

The docs notes were, in many ways, even worse. The notes required manual typing, and many docs are not trained skilled touch typists. So the two-fingered part of the note was often very brief and succinct. The templated portions were huge - impressive reviews of systems where you could not really tell if the specific items had actually really been asked or if the template just vomited forth a page full of text for administrative review.

Make a doctor function as a data entry clerk and this is what happens.