Abstract: Changing Centuries of Health Communication Documentation: Innovation or Chaos

◆ Hanna Cooper Birenbaum, University of Miami
◆ Michael Pagano, Fairfield University

The purpose of this study was to explore and analyze the evolution of health communication documentation, channels, and policies related to patients’ medical records from 1754 to 2023. This historical research examined, using causing analysis and processes over time, the ways in which patients’ health records have evolved from Benjamin Franklin’s first description in 1754 until today. Specifically, this paper focuses on how the innovation and requisite adoption of the electronic medical record (EMR) versus hand-written documentation impacted provider-provider and patient-provider communication. Based on the government’s HITECH Act (2009) requiring EMR development, physicians became concerned that policymakers, insurers, and organizational administrators could use EMRs to pressure, impede, and/or negatively impact the overall practice of medicine (Ford et al., 2009). The current study explores how the communication of patient and/or provider information has not only transformed from paper to an electronic channel, but also how it impacted the interactions and information-sharing of patient-provider and provider-provider communication. In addition, this paper addresses how the innovation did little to improve geographic access to documents, while negatively impacting provider autonomy and increasing economic costs for U.S. taxpayers. This study also explored how the changes over the past 20+ years have affected interpersonal communication, clinician time-management, and potentially clinical outcomes. The current analysis found that over the past 250 years in America, the documentation of patients’ illnesses, injuries, and wellness have evolved technologically, but without enhancing patient-provider interactions. At the core of this alteration in health communication are the resulting concurrent dialectical tensions between: documentation and time-management for providers and interpersonal information exchanges and relationship-building with patients. Furthermore, these tensions were by and large not created by providers. Congress, with the passage of the HITECH Act in 2009 both provided financial incentives for hospitals to convert to computerized health record-keeping and concurrently promised reduced payments for Medicare/Medicaid patients treated at hospitals that did not use EMRs (Centers for Medicare & Medicaid Services, 2018). As a result, the second-decade of the new century would see huge changes in provider-provider, provider-organization, and provider-patient electronic communication that most of the authors of these e-documents, and their institutions, were ill-prepared to develop and/or utilize effectively—creating communication dilemmas (Ash et al., 2003; Berger & Kichak, 2004; Campbell et al., 2006). This current historical analysis demonstrated clearly the past and present complex, critical, and chaotic evolution to electronic record-keeping. The persistent lack of a centralized “cloud-type” storage and retrieval mechanism to make the EMR truly a geographically available e-health tool still does not exist. In spite $27 billion allocated by Congress (Nguyen et al., 2022) for EMR development and usage—providers still cannot access patient records from a different health system, in the same city, let alone across the nation. Based on the findings in this study, the need for collaboration between lawmakers, providers, and health communication scholars is critically necessary to address communication, access, and time-management issues that are negatively impacting health care with the current EMR record-keeping channel.