Electronic medical records, or EMR’s, are currently being advocated by federal and state governments, insurance companies, and large medical institutions because of their increased ease of access, portability, transferability, and reduced cost of storage. As an incentive, Congress issued the American Recovery and Reinvestment Act in 2009, which gave up to 44,000 dollars per physician under Medicare, and up to 65,000 dollars (over six years) under Medicaid. At this point, most of us know about the incentives. Nonetheless, due to various challenges, the adoption of EMR’s is under scrutiny, both from within the medical profession, and without.
Despite President Obama’s claims that the adoption of EMR’s will save around 80 billion dollars, and improve patient care through increased efficiency, there is considerable dubiety about the merits of implementing electronic records (Groopman 2009). Foremost among the concerns discovered by a Kaiser Family Foundation telephone survey (conducted March of 2009) was patient privacy (Daly 2009). Indeed, 76 percent of respondents believed that it would be ‘very or somewhat’ likely that someone could access their electronic record without authorization. Secondly, total cost is a significant concern. The Agency for Healthcare Research and Quality concluded in 2005 that larger clinics would incur a cost of $32,600 per clinician while smaller practices would run a cost of $37,200 per clinician (Daly 2009).
EMR’s also pose a significant technological challenge: it will be absolutely necessary to keep the patient record system available at all times; if the system slows or crashes, patients could be imperiled by lack of access to vital information. This does not even begin to address the concerns of more malicious incursions, such as viruses, worms, and Trojan Horses. Additionally, EMR’s may cause a lack of human interaction in health care. Currently, physicians have the liberty to record their own thoughts and observations about patients, in their own words; under EMR protocol, physicians would merely be filling out a standard form (ticking, and crossing-out). It is possibly dangerous when doctors are forced to think categorically, and not with greater expression and flexibility. This can lead to possible mis-diagnosis.
Another problem in EMR is lack of efficiency, an irony that belies the original claim of transferability and ease of access. It has been conjectured, for example, that one clinic’s EMR system may be incompatible with another’s (or another physician’s) which causes challenges when sharing patient records. A drawback to EMR adoption is the initial challenge to medical staff. Massive re-training will be required; this may lead to a huge drop in quality of patient care while staff members learn the new system.
The massive drive behind nationwide Health Information Technology (HIT), and EMR’s in particular, is propelled by a faith in its benefits: increased efficiency, reduction in overall costs, and better overall care. The obvious virtue of instant access through an “interoperable system” which exchanges important patient data is obvious (Daly 2009). Two clear benefits will be a reduction in errors and the provision of essential alerts about lethal medicine interactions.
Despite the overwhelming privacy and safety concerns, it seems that the benefits of an interoperable HIT system outweigh the problems. What is required now is an exhaustive survey of other medical systems (for example, the Netherlands, and Canada) which have implemented such systems, and what they have learned about the process. From our own ideas, and the experiences of others, we can fashion an interoperable HIT system that is secure, reliable, and inexpensive.
Santa Rosa Consulting has the expertise to assist you in navigating and mitigating the negatives of EMR. Our consulting professionals have the real life experience that enables our customers to prepare properly to embrace this most important technology initiative. Please give us a call, and will assign a company representative to work closely with you in defining your needs.
Aarin Esler, Senior Cerner Consultant
References
Daly, Rich. (2009). ‘Huge challenges’ could hinder electronic record adoption. Psychiatric
News, 44 (10). Retrieved from http://pn.psychiatryonline.org/content/44/10/16.1.full.
Groopman, J., & Hartzband, P. (2009). Obama’s 80 billion exaggeration. The Wall Street
Journal. Retrieved from http://online.wsj.com/article/SB123681586452302125.html.