Wednesday, December 2, 2009

Electronic Medical Records - The Trouble with Tribbles

Electronic medical records (EMRs) are slowly transforming the delivery of healthcare. EMRs are intended to securely keep track of a patient's entire medical history in a computerized format. By keeping these records electronically, they are easily accessible; have the potential to help identify the most cost effective treatments; and can make navigating through the healthcare system much safer and more efficient.

The potential benefits of EMRs, such as substantial healthcare savings and the ability to share a patient's health information to avoid unnecessary testing and prevent medication errors, sounds appealing to most physicians yet many healthcare providers remain hesitant to implement an EMR system.

One of the challenges of implementation is cost. Although financial incentives are being offered by the Medicare Program and President Obama's Stimulus Package, there are still significant expenses involved for physicians with the purchase of software, infrastructure, installation, and maintenance. Indirect costs are also realized in training staff on data management and entry. "Medical decision making" data entry, in particular, is very time consuming and by far the most expensive aspect of converting to electronic records.  There are huge amounts of older patient data stored at insurance companies, hospitals, pharmacies, and laboratories that need to be cultivated, shared, and checked for accuracy by the patient with the help of a skilled clinician in order to have a complete patient profile.

Incorrect information can lead to a cascade of inefficiencies.  If a patient is wrongly identified as having an allergic reaction to X-ray dye, for example, a red flag alert comes up on the chart anytime the patient goes to a medical facility. If an emergency situation arises where the best test requires the use of X-ray dye, hours are wasted trying to identify the truth and avoid liability. Currently, even if identified, there are few mechanisms available to correct this misinformation in organizational computer systems.

An experienced primary care provider who knows the patient well and has all medical information flowing through their office is the obvious entity to input and screen new information important for medical decisions. Primary care shoulders the largest burden of "raw" data vetting and, therefore, the cost of implementing an EMR. Unfortunately, these are the same practices that are the least financially capable of absorbing these expenses.

Another challenge of physician office based EMRs is the inability to collaborate back and forth with local labs, hospitals, and other doctor's offices. Any interconnected central repository that could communicate effectively in a standard medical decision based format is still many years away from being a reality. The potential is real, but it will need strong leadership and national standards to achieve this lofty goals.

Currently, less than 30 percent of physicians have installed an EMR system. So, if a physician seems slow in adopting health information technology, show some compassion.

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