DOCTOR IS IN: Electronic Medical Records bring slow but substantial change

BY MARK WULKAN, M.D.

Surgical Director, Pediatric Intensive Care Unit and Director, Minimally Invasive Surgery Center, and Medical Director of Informatics, Children’s Healthcare of Atlanta; and Associate Professor of Surgery and Associate Professor of Pediatrics, Emory University School of Medicine

The electronic medical record (EMR) is slowly transforming the way doctors, nurses, and other health care providers deliver patient care. Patients financial records have been electronic for decades; however, clinical data (the information entered by doctors, nurses, and other health care professionals) has been lagging. Processes for capturing lab and radiology results, history and physical details, operative reports, discharge summaries and other critical data have been very basic; paper charts remain the primary means of documentation and communication among the health care team.

Today, some hospitals are creating comprehensive EMRs for their patients that include the documentation and orders entered by all health care professionals. These EMR systems help:

Make it easier to access and share patient information among doctors, nurses, respiratory therapists and other health care professionals, regardless of whether they’re in the same unit, on separate floors or even away from the hospital. For example, if the doctor caring for your child in the hospital gets a call after she’s home, she can access nearly all the information in your child’s medical chart via her home computer (with the appropriate security clearance).

Allow your physician to order medications and procedures with the added benefit of EMR system “guard rails” that generate alerts to prevent errors, such as an overdose, giving a medication your child is allergic to, or prescribing drugs that are incompatible.

EMR systems designed for offices perform many of the same functions, just on a smaller scale.

Most of the top medical centers in metro Atlanta have implemented or are in the process of implementing a comprehensive EMR. Yet, the transition to comprehensive EMRs has been slow. In fact, a study published in the New England Journal of Medicine last year found that only four percent of physicians had a comprehensive EMR and 13 percent had a basic system. The primary barriers have been cost and time. Over the next several years, you should see an increase. The federal government is encouraging hospitals, clinics and doctors’ offices to do so and the American Recovery and Reinvestment Act includes stimulus money to help offset part of the cost.

In the future, as more EMR software manufacturers adopt international standards, your records will be electronically available from nearly any medical facility that you and your family visit.  For example, if your child gets sick on vacation in Florida, you will be able to grant access to his pediatrician’s records and any previous hospitalization records to the Emergency Room doctor taking care of him. In addition, your pediatrician will be alerted and have the ability to access information about the ER visit. The details of how this will work are still being discussed, but this is the goal.

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8 comments Add your comment

JG

August 31st, 2009
10:08 am

Dr. Wulkan,
Your article is correct. I work in the Healthcare IT industry. The EMR adoption has been slow, but the industry needs more Physicians like you, to embrace this technology.

Michelle

August 31st, 2009
10:48 am

What about patient privacy? Has anyone here ever been to the doctor about something somewhat embarrassing that you don’t want people reading about years from now? Seriously. How can the fact that someone got a tampon stuck up them and had to have it removed have any bearing on their health years down the road? How many of you know someone who works at a hospital or doctor’s office and all these records will now be available for them to read. Don’t kid yourself people. There will be no privacy once everyone’s medical record becomes available for people to read.

Cutty

August 31st, 2009
5:21 pm

Michelle,

What type of privacy does one have with their financial records? Is that information readily available to anyone with an internet connection? I think not. Those that work in hospitals already have access to the records in your paper file. Get Real, this is much needed. I once dropped off a prescription at the pharmacy for my asthma, and received the wrong medication because the pharmacist couldn’t read the doctor’s handwriting. EMR’s would take care of that. Your assumptions are eerily similar to ‘death panels’. Don’t listen to everything Rush and Hannity tell you.

Michelle

August 31st, 2009
10:01 pm

I work in the field. I use EMR records every single day. I don’t know about the financial end of it, but I do know about the medical end. Any time you see a doctor for any reason, there will be a notation of it. From then on, anyone who access to your EMR record will be able to see a note from that visit. Like I said earlier, any embarrassing thing that you might want to put behind you will now be available for future doctors, nurses, office personnel, hospital personnel to see.

People who work in a hospital now do not have access to the paperwork from every single doctor visit you ever had. I really don’t think you know enough about EMRs to be commenting on this. Sorry.

Michelle

August 31st, 2009
10:02 pm

Cutty,

By the way, I never listen to Rush or Hannity.

lori

September 1st, 2009
6:39 pm

First off, Dr. Wulkan, I think this is a great article. EMR adoption has been slow, but as more facilities and physicians adopt it, and as more patients are introduced to it, I think that it will help change the overall way we approach healthcare, making it more of a team, or partnership, effort. I would like to see greater conversation between doctors and patients, which requires interoperability. I use HealthVault to record my family’s visits, innoculations and other medical information. It would be outstanding if I could share that information with all of our various doctors instead of the paperwork process I currently go through. And it would be easier, I have to believe, on the various doctors, for them to be able to see in a glance what doctors a family member has seen, and what medications they are on (how many times do we not know the dosage or the actual name of the medicine). As for the privacy issues that have been brought up, perhaps there will be a way to tab specific visits that are non-essential for an overall diagnosis. I for one thought it to be hysterical when I went into an urgent care recently, having sliced my finger nicely. Specifically, the date of my last menstrual cycle or pap smear have absolutely nothing to do with suturing my finger. It’s perhaps a matter of better “filing” of necessary data.

Electronic Medical Records

September 15th, 2009
9:50 am

Patients can access their electronic medical records online with MRI: https://www.medicalrecordsinternational.com and even get 30 days free trial. They can control what to share and what not to share with doctors.