The computerized record can be more of a hindrance than a help in retrieving the needed information. The pertinent data can be buried in irrelevancies, contaminated with errors and bias, and organized in a way that is not appropriate for the clinical situation or the individual physician's approach to clinical problem-solving. As to advances in research, there is no reason to believe that having every patient's clinical record on-line will lead to scientific advances. Those who promote this belief tend to speak in generalities rather than formulating specific hypotheses subject to testing. The pitfalls in research based on clinical records are summarized in the accompanying article from the Medical Sentinel .
Data now present in the clinical record are of highly variable quality.
Data entered because required on a checklist are likely to be of much less value than items entered because a clinician believes them to be relevant, important, and reliable. Data entered in order to justify payment may be colored by financial incentives. While better compliance with stated objectives can be achieved, it is not clear that any measurable benefit accrues to patients. One problem with CQI is that compliance is not the proper endpoint. The goal should be to make the correct diagnosis and provide the optimum treatment for an individual.