EMR Systems

Doctor using computer

Healthcare, along with construction, education, and retail are ranked as being the slowest adopters of Information Technology (IT), according to EMR Experts. Computerised information systems have not achieved the same degree of penetration in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries.

An electronic medical record (EMR) is usually a computerized legal medical record created in an organization that delivers care, such as a hospital and doctor's surgery. Electronic medical records tend to be a part of a local stand-alone health information system that allows storage, retrieval and manipulation of records.

In the US, one-quarter of office-based physicians reported using fully or partially electronic medical record systems (EMR) in 2005. However, less than 10 percent of these physicians actually have a "complete EMR system", with all four basic functions deemed minimally necessary for a full EMR: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.

If medical records were electronic, prescriptions would be more legible and could be filled more accurately. Public health officials could spot disease outbreaks quickly and track their spread. Doctors could speedily check a patient's record, helping to avoid wasteful repetition of tests and minimize harmful drug interactions and other errors, which kill an estimated 98,000 people a year in the US.

Not only can EMR systems make it easier to treat patients, they can protect patient confidentiality as they show "audit trails", showing who has looked at the files, the LA Times reported back in 2006.

Yet, a major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times report, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.

When President Obama designated $19.5 billion to expand the use of electronic medical records, former House speaker Newt Gingrich (R-Ga.) said it was one of only "two good things" in February's stimulus package. Under the stimulus program, hospitals and physicians can claim millions of dollars for IT purchases, and will be penalized if they do not go digital by 2015. Obama has said the changes will save billions and will minimize medication errors.

Despite Obama wanting to expand the use of EMR's, there has been problems reported by the use of them. According to the Washington Post, more than one in five hospital medication errors reported last year - 27,969 out of 133,662 - were caused at least partly by computers, according to data submitted by 379 hospitals toQuantros Inc., a healthcare information company. Paper-based errors caused 10,954 errors, the data showed.

As well as that, some have reported that productivity has gone down.

"It's been a complete nightmare," said Steve Chabala, an emergency room physician at St. Mary Mercy Hospital in Livonia, Mich., which switched to electronic records three years ago. "I can't see my patients because I'm at a screen entering data."

Last year, his department found that physicians spent nearly five of every 10 hours on a computer, he said. "I sit down and log on to a computer 60 times every shift. Physician productivity and satisfaction have fallen off a cliff."

The future

In the US, the development of standards for EMR interoperability is at the forefront of the national healthcare agenda. EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (lab results, public health reporting) which are necessary for timely, patient-centred and portable care.

The argument for EMR's seems like it's going to be another issue to plague the healthcare reform.

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