Electronic Health Information - EMR or EHR
There’s a revolution going on. Slowly, medicine is shifting from paper based medical records to a computer-based system that’s likely going to impact you. Currently about 15% of hospitals and physicians have made the switch to electronic record keeping. The rest still use paper as has been the standard for decades. However, despite their familiarity, there can be drawbacks to using paper. Handwriting comes to mind immediately as I’m sure you know the old saw about doctors and legibility. Also, think about a chart that’s 3” thick from a patient who’s had the same doctor for many years or a couple significant illnesses. And, if you want this information transferred to your new physician when you move, but the original chart stays put, it can prove problematic. Culling specific test results from a chart like that can also be challenging.
In 1999 it was estimated that there were as many as 98,000 medical error related deaths annually in the U.S. A measurable percentage of those were caused by errors in medical record keeping or retrieving previously obtained information be it from physicians, pharmacists, nurses, lab personnel, etc. That said, as you’d expect the electronic record has its drawbacks as well, some of them quite significant. Anything that can happen to computer based files, good... and bad as we see frequently in the media, could potentially occur to your private medical information. This risk is present despite encryption, passwords, etc. (Think Julian Assange – WikiLeaks. Think about the big information loss that the VA system had a few years ago.)
As you might imagine, the change over is anything but free. I’ve read that it can be as much as $40 - 50,000 per physician. Then there’s a pretty steep learning curve where the doc has to cut his/her schedule in half at least short term limiting access. The top of the medical diagnostic team becomes the transcriber as well , oftentimes never really regaining the current level of efficiency.
And the personal nature of paper, little notes you leave for yourself, specific to each particular patient, like to say thanks again for the brownies they brought you at the last visit, seems to be lost with computerization. On the plus side, overall staff needs will decrease over time. The American Recovery and Reinvestment Act of 2009 provides an incentive to make this change and eventually those physicians who’ve chosen not to adopt EMR may be penalized up to 3% of their Medicare reimbursement as early as 2015.
As I write this, my wife’s practice is in the middle of this change. They enter the exam room, computer in hand, and some patients note that, “The doctor spends more time looking at the computer than me.” And they’re right. But to even get to that point, the doctors are spending endless hours, working well into the night, and sometimes into the very early morning, to get that patients labs, medicines, x-rays, notes, etc. into the electronic document for that days visit. Yep, there’s stress on both sides of the white coat.
So, we’re a system in transition. And change, any change, is often uncomfortable. But as doctor and patient both get used to “the new way’” advantages will become apparent, errors will hopefully continue to decrease and the quality of care, your care, improves steadily. And, anything you can do to help is most appreciated!
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