Paper medical charts have largely gone the way of nurses' whites, and so have some jobs that old-fashioned health records used to require.

But other jobs have changed and 10 years of experience with electronic medical records, or EMR, have revealed the need for new and expanded roles within health care.

On their way out
Having medical records as close as a computer screen has lessened the need for medical transcriptionists, who listen to physicians' dictated notes about each patient encounter and type them into a chart, according to Wendy Weeks, director of Electronic Medical Records (EMR), Web and Mobile Patient Services at HealthPartners Medical Group & Clinics ( "We definitely still do have folks who do transcription work and physicians who transcribe their notes," she added.

The EMR has created shortcuts so physicians and other health care workers can use computer templates that are unique to each patient visit, according to Andrew Wineinger, manager of HealthPartners' ambulatory electronic medical record.

Two classes of jobs
The EMR has created two classes of jobs: users and support staff. Users include physicians, nurses, registration and rooming staff, medical coders and review specialists, Wineinger said. Support staff includes trainers, help desk workers, application and enhancement personnel, database analysts and project flow coordinators.

The latter role is one no one thought of early in the EMR era, but is needed to track how information flows through the system, according to Weeks. HealthPartners has business analysts and project coordinators who identify how information flows from nurses to doctors to pharmacists to patients, she said. Systems analysts apply technology to make sure it all flows smoothly.

Can you hear me now?
More physicians are using voice-recognition software to dictate their notes directly into a computer, but occasional glitches still make human transcription review necessary, Weeks said.

"We are consistently being asked to modify and make improvements, which really demonstrate the value of the system," she added. "People use it in every exchange they have with a patient, and they say, 'It would be even more helpful if you can 'fill in the blank.'"

Everyone in the clinic uses the EMR in some capacity, according to Wineinger. "As we continue to look at things like quality and other opportunities that still exist, as we look at diseases and how can these systems provide better and timelier information … that will always be a continuing need and growing need," he said.