Stanley Feld M.D.,FACP,MACE
The New York Times article presents me with an opportunity to discuss the issue of the adoption of EMR in physician terms. Media reporting tries to be neutral and informative. It usually produces nothing but confusion.
“The report published in the NEJM also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors.”
The EMR adoption rate by large physician groups of physicians is still low. 49% of large practices still do not have an EMR.
“Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.”“ In the e-mail, Justen Deal, a project supervisor who has worked for the company for two years, detailed his frustration with Kaiser's electronic health record system, which he considers inefficient and unreliable.” “Deal was placed on administrative leave.”
We have little information about the effectiveness of Kaiser’s EMR presently yet it is presented as a successful system in the New York Times article.
The promise of an EMR must be realized in the next few years. Only innovative thinking will precipitate the necessary paradigm shift toward EMRs rapid adoption. It must be done quickly before it is too late.
Using an EMR can provide finger tip information to physicians about patients they treat. If set up correctly it can speed up data entry on patients and be a guide to complete data entry for particular diseases. It can serve to improve the quality of clinical decision making by interconnecting to clinical practice guidelines. It can be used to avoid medication errors with the use of e-prescription and can point out potential drug interactions. It can be used as a guide for patient education to prevent the complications of chronic diseases. It can increase productivity of physicians by electronic delivery of laboratory findings. It must be formatted as a physician extender and not a physician substitute.
After a sometime steep learning curve physicians are satisfied with the electronic medical record. The NEJM study was a little exuberant with its statistic reporting that over 80% of the physicians were happy they had an EMR when the EMR was fully functional (3.2%). Not all EMRs in large clinics are fully functional.
The study found that a paltry 4 percent of the doctors had a “fully functional” electronic records system that would allow them to view laboratory data, order prescriptions and help them make clinical decisions, while another 13 percent had more basic systems.
Within a large clinic the electronic medical record should be totally transparent to the physicians across clinical and business functions. Patients can log in and get their records and laboratory results, physicians interpretations and radiological findings immediately and have a PMR (Personal Medical Record). The EMR could also improve communications with other physicians.
Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.”
He could not afford conventional software, and chose a Web-based service from Athenahealth, a company supplying online financial and electronic health record services to doctors’ offices.
There are not many physicians in the United States that would trust their records to be outsourced at this point in time. However with the proper protections web based online electronic medical records could work.
Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.
“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”
This is a reason we need a ideal and universal EMR. However, the ideal EMR must have the ability to be used as an educational tool for patients and physicians. EMRs should be standardized and then customized by physicians to mimic physicians practice patterns. They should make medical care more efficient and less costly. Dr. Masucci is simply a testimonial stating that he has gotten rid of his paper record. However it might not be increasing his problem solving ability or his ability to transfer information or treat chronic diseases using evidence based medicine. The problem with most EMRs is they do not provide full functionality needed to solve the many problems in the healthcare system.