Within the last few years there as been an aggressive push on the part of government, professional organizations, and other authorities to institute a uniform EMR system. This includes generous subsidies allocated by recent legislation and mandatory legal requirements to occur in the next few years. As a practicing and academic physician with a masters degree in public health, I would like to briefly note some observations.
Intuitively, a uniform, easily accessible EMR seems like a very good idea. In fact, one of my major difficulties in practice occurs when a new patient arrives without copies of previous diagnostic studies or lists of medications. This is compounded in an incapacitated or elderly individual with many medical conditions and medications, and when there is a language barrier. Such patients may have great difficulty, or be incapable of, relaying this information to the new physician. To go online and immediately retrieve it would be very helpful indeed.
However, in these days of lower reimbursement and higher practice volumes, time spent imputing information may be time spent away from patient care. You may have experienced a visit where your doctor, using an EMR, has his eyes and hands on the computer much more than on you. I personally have accompanied relatives to physicians and emergency rooms where the doctor spent almost no time talking to, or examining the patient but instead sat in front of the computer, recording or retrieving information.
Also, these electronic records include templates where “check off” of existing information, rather than recording of original information is involved. This helps improve physician reimbursement by conforming with insurance company guidelines for level of service. It does little, however, to record the doctor’s thought processes or enhance the necessary medical information provided by this specific physician.
Don’t get me wrong. Good information is a good thing. But, it must be good for the patient and not just there to satisfy an insurance company. Also, it must contribute to, not detract from, the overall quality of care.