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DOCtalk with Dr. Gregg 6/23/16

June 23, 2016 Dr. Gregg No Comments

EHR Litter

Hot topics in HIT these days are all around interoperability, big data, data exchange, MACRA, etc., all of which pretty much revolve around the generation of data. But before we get too far down the data-generation path (if we’re not there already), maybe it’d be a good idea to consider a much less sexy concept – the notion of “EHR litter.”

In all likelihood, you’ve never heard of EHR litter before. I hadn’t. In fact, I think I may have coined the term. It came to me one day when out mowing my lawn …

Living on a fairly busy street in our town, one of the seemingly incessant scourges is that of litter. As I was picking up the fourth piece of somebody’s waste – a used Kleenex, I believe it was, yuck! – it struck me yet again how lovely it would be to just once mow the grass without having to handle the often gross refuse of my neighbors.

As I mowed on, it further struck me that so much of the detritus that I receive in digitally-created notes from hospitals and other providers is very similar to my yard experience: There’s good stuff in there, but doggone if there isn’t a whole heap of “litter” that just wastes my time!

Think about it. If “big data” is ever going to get us anywhere, it should be big, useful data, not copy-paste crap that often isn’t actually applicable to the current patient note, or system-generated phrases that add no value to the medical story other than making it easier/faster for some poor clinical schlub to get through his dullardly data-capture duties and get his bullet points all clicked to ensure reimbursement.

Whether obtained via fax, PDF on CD or flash drive, C-CDA, or secure messaging, so much of the “medical” content that we providers now have to wade through is like so much litter; it’s truly trash that takes time to scrounge through and wastes digital space. It serves no purpose for ongoing patient care.

To be honest, sometimes I’m not sure if it is any better than the old handwritten pen-and-paper notes that were often illegible. Both waste provider time, both provide limited (if any) value, and both are fairly infuriating. Both are, essentially, medical content litter.


All this waste-of-space content will divert us from our goals of making big data useful, data exchange worthwhile, and interoperability efficient.

I promise to do my best to eliminate “litter” from my notes. I hope you – be you provider or EHR vendor – will do your part to get rid of your EHR trash.

(And, if you happen to drive by my yard, please don’t throw your trash out there, either.)

From the trenches …

“If what I write is literature, I guess you’d better emphasize the ‘litter.’” – Lydia Lunch

dr gregg

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is chief medical officer for Health Nuts Media, an HIT and marketing consultant, sits on the board of directors of the Ohio Health Information Partnership, and is the semi-proud author of “Monsters Don’t Fart!


JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg

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