Sunday, May 1, 2011

LAGNIAPPE


A doctor's take on digital medical records

This was a response to "Medical records going digital; Electronic systems expected to reduce costs, improve care" (Page 1, April 12),  by Chicago Tribune reporter Bruce Japsen. The story touched upon the privacy concerns of the patients; however, many other logistic concerns were ignored, in the view of the doctor whose Voice of the People letter follows:

 In my successful suburban solo family practice of several years, I did not use electronic medical records. Knowledge of each patient I served was on the tip of my tongue when an emergency-room doctor seeing one of my patients called in the middle of a night. I was available 24/7 with few exceptions. The paper records were organized such that I was able to access clinical details quickly when needed.

As I stepped into the role of a chief medical officer and a teaching faculty member at a Federally Qualified Community Health Center dedicated to serve our safety-net populations (uninsured, underinsured and Medicaid patients), with 25-plus physicians, including residents in training, we all realized that a popular brand of EMR in place was no panacea! It prevented us from functioning efficiently, caused frustration and lowered staff morale. The system was slow generally, froze up a few times a day and crashed every few months, requiring us to reschedule patients. Pricey service calls, multiple system updates, periodic shutdowns, user training and hiring of a full-time IT expert at a significant cost helped some, but the dissatisfaction persisted. Our experience taught us that:

• IT systems are still in development; warranties and service agreements often leave a buyer unprotected.

• Federal incentives for adoption of EMRs come with complicated bureaucratic requirements.

• Small practices and already challenged safety-net hospitals cannot afford on-site dedicated IT support.

• Documentation and accessibility of information in EMR is more time-consuming than paper records.

• Significant user training and practice are necessary; more than just email skills are required for EMRs.

• Data backup is a prudent need and often requires additional investment.

• Physician office EMRs may be incompatible with the systems used by hospitals in that community.

• Some pharmacies sell electronic prescription data to drug companies. Does that pose risk to patients?

• HIPAA laws and local facility rules can discourage unauthorized access but do not fully prevent it.

On the flip side, compared to paper records, the information in EMRs is legible and relatively easily available for quality measurements and reporting purposes. It is doubtful, following my review of hundreds of EMRs, that English grammar gets any more respect in the EMRs, if patient care is any better or safer, or if there is a built-in cost saving attributed to the use of EMRs.

I guess, after spending the next several million dollars that we do not have, we may gain a better understanding of the value and "meaningful use" of the EMRs.
--Dr. Arvind K. Goyal, clinical associate professor, Family Medicine and Preventive Medicine, Chicago Medical School/Rosalind Franklin University, past president, Illinois State Medical Society