Are Electronic Medical Records Really the Salvation of the Health Care Sstem?
Many in government are convinced that EMR (Electronic Medical Records) and HER (Electronic Health Records) are an essential requirement for improving the American health care system. But those of us in medical practices, while there are important benefits in the use of EMR/HER technology, are not as convinced of the long term benefits of such technology given the current state of the software industry that makes up this market especially give the cost impact n private medical practices.
First a couple of definitions:
1. An Electronic Medical Record (EMR) is a computer based system to record the medical record of patients within single medical setting, be it a doctor’s office, hospital, clinic or any other setting.
2. An Electronic Health Record (HER) is a computer based system to record the medical record of patients in a shared medical setting such as an Integrated Health System, a hospital with an employed staff, or a large multi-specialty clinic.
So while they are similar in function, the difference is that the EHR is a medical record shared between many providers of different medical specialties in a large organization and most EMRs are only used in one location among providers who provide the same medical services. So within North Suburban Eye Associates, Drs. Evans, McNulty, Singh, Sinha, Cherian and Trail all share the records within our NextGen EMR but those records are not available providers outside of our practice. Partners Health Care’s LMR, their EHR system, is available to all the 5000+ providers providing any type of medical services within the Partners network of hospitals and offices.
EMR/EHRs all capture basic information such as patient allergies, medications they take and a history of their medical problems, treatments surgeries, and diagnostic test results. But the difference is that the great majority of these records, being part of EMR systems, are not available to providers outside of the office in which they are recorded. So you as a patient have information in your PCP’s EMR, your ophthalmologist’s EMR, your cardiologist’s EMR, your OB/GYN’s office, etc. But your PCP’s information is not available to your ophthalmologist, cardiologist or OB/GYN because the individual systems do not “talk” to each other. Nor is any of the information in your specialist office available to your PCP, who is supposed to be coordinating all of your care, in some type of electronic exchange of information.
And even in the large medical settings that have an EHR, those records are not available to other large medical settings which have a different EHR system despite the Federal Government’s attempts, started early in George W. Bush’s administration, to define the standards that are needed to permit such an exchange of information. Years of meeting and millions of dollars have been spent chasing this goal with little or no success.
So why all the emphasis on EMR/HER at the policy level? Part of it is because the policy makers, especially the state and Federal legislators involved in the development of the laws, regulations and incentives, do not understand the technology but are being convinced by the large players in the markets, the hospitals, insurers and policy wonks, that this is the wave of the future. Some of it is that despite the interoperability issue not having been solved, there are some practical benefits of such systems. The medical records are legible because we don’t have to interpret provider’s handwritten entries. The prescriptions, when written, are evaluated against the other medications the patient is taking to identify potential harmful interaction among those medications and against drug allergies identified in the patient’s record. And it is easier to analyze data in any one EMR/HER for potential benefits provided by various medical diagnoses, treatments or medication regimens.
But they are not beneficial in providing ONE CENTRAL data repository for all the medical information for any one patient and it will be years before that reality is reached, if ever. The nature of the medical marketplace, with the competition among providers, the plethora of insurance plans serving the market and the basic complexity of the American health care system, will make it extremely difficult to achieve grasping the brass ring.