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Electronic health records: Medical miracles or digital disaster?

Ano Lobb | Tuesday 17th November 2009

Electronic medical records (EMR) are digitized versions of the paper folderswhere your doctor squirrels away your health information. They are increasingly being looked to as a solution to what ails modern healthcare. Ideally these digital records can be shared quickly and efficiently among providers, can be programmed to remind doctors about test results or to warn about medication interactions, and can eliminate that ever present problem of illegible handwriting. These are all good things, but it's unlikely that EMR are the solution.

To begin with, evidence suggesting that EMR can increase quality and reduce costs within the US healthcare system comes primarily from studies at flagship institutions such as Intermountain Healthcare: systems that already practiced stellar care, and had the ability, motivation, finances and structure that allowed them to successfully integrate EMR into existing operations. Some of the challenges tarnishing the promise of EMR:

1. Cost: Transitioning from a paper system to an electronic one is expensive. Estimates range widely, anywhere from $20,000 to $70,000 per doctor's office, more if you are a hospital.

2. Where's the system? Let's assume that sufficient safeguards can be built in to ensure that the records are only available to those with permission (a very big assumption in its own right.) In ordered to increase care coordination by enabling quick and easy data sharing, all doctors, hospitals and clinics need to be tied into the same system. That can only happen if all EMRs are linked together. With literally dozens of systems currently available and in operation, that is not the case. Information remains squirreled away in digital silos, inaccessible to the network of providers thatdeliver modern care.

3. Electronic prescribing is a practice tied with EMR that has great promise. The computer can check for interactions with existing medications, ensure the dosage is appropriate, automatically remind providers when to stop or renew prescriptions, and eliminate illegible handwriting. These systems are also expensive, resulting in the launch of no or low cost programs from the pharmaceutical industry, who program in various ways of encouraging docs to prescribe their drugs over competitor or generic products. That's a sure route to more expensive, less effective medicine.

4. In an era where you can be denied care based on preexisting conditions, we may not want all data aggregated in one place for all time. Current legislative proposals aim at eliminating pre-existing condition clauses in health insurance, but laws change.

5. Logistics and reliability. How does the doctor interact with the patient when he/she is staring at a computer screen? What if a lab result is coded incorrectly, and stored in the wrong place, will you ever be able to locate it? What happens when the computer crashes?

EMR certainly has promises, but in the free market of American health care, its unlikely to improve quality, lower costs, or improve the health experience of doctors, nurses or patients.

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sharon McDonnell 9 December 2009

I did a fairly extensive review of physicians experiences with EMR and the news is bad. It seems that EMR's have some unintended consequences: 1) Decrease eye contact with patients, 2) Reduce the ability to reflect or synthesize medical information and instead parse data into fields. 3) increase sense of risk of legal suits because they must respond to all fields ie checking pupil reactivity. 4) Less staff such as medical records and ward clerks to assist in routine work-- we turn doctors into data entry clerks. The major outcomes: 1) increased ability to bill individual events in patient care 2) better detection of pre-existing disease 3) no improvement in available information. The lack of universal coverage means that diagnosis is stigmatized and HIPPA means that records outside one system cannot be available to others. Finally, no improvement in reporting public health events such as disease and death because the systems are not designed to collect this. Its about money not health.

Anne McCrady 17 November 2009

With a father, husband and daughter who are physicians, ten years of medical administrative experience and a chronic illness, I encourage you to talk to doctors about your opinion. Some version of the obstacles you cite could apply to most industries and yet most businesses have digitized. There are countless studies which show how quality, safety, efficiency, collaboration, integration and customer service are all improved with an electronic medical record. Expense is the biggest obstacle -- health care reform may yet help with that. Anyone who thinks they might one day be a patient should cheer the idea of an electronic medical record.