Electronic Medical Records – A Mixed Blessing

Posted by on Feb 7, 2013 in Health, News | 0 comments

Electronic Medical Records – A Mixed Blessing

 

We had great hopes. A series of revolutions in data management and processing in the 1990s and 2000s were combining to make huge reams of data cheaper and easier to store and manipulate than ever. Everything from scanners to bar codes to easy electronic data transmission to specialized software and even Windows seemed to promise to make it much easier to handle patient medical records – and more accurate in the process. The potential for human error, argued advocates of automation, would be greatly reduced or even eliminated, depending on the process.

It sounded great back when Bill Gates was writing his book The Road Ahead.

And Congress has certainly thrown a lot of money at the problem – spending $6.5 billion on grants and incentives to health care organizations to upgrade and modernize their IT backbones to handle a newly-digitized medical records system.

But it hasn’t worked out as well as hoped so far.

Health care costs – quite apart from insurance premiums – continue to rise, and we have not seen the benefits of records modernization that we had hoped for show up in actual cost data.

Part of the problem, say some health care practitioners who are working with electronic medical record (EMR) systems in the trenches: Data entry. Although transmission is easy, the standard templating systems encourage doctors and caregivers to write notes by clicking on boxes to make the process go faster.

The process goes faster, but we lose a lot of accuracy in the process. Which makes it more difficult to provide timely and accurately prescribed follow-up care. The templates pre-programmed into a system cannot possibly anticipate all the relevant details that may apply to a patient designated to be at elevated risk of heart attack.

But the EMR system and a compliance-based inspection system encourages practitioners to use the standard template responses to create EMRs. Indeed, if they don’t, and deviate from the system, they may have perceived billing issues with Medicare, Medicaid, or even some private insurers.

The inaccuracy built into the system has costs of its own.

Furthermore, hospital, county and state IT staff and resources have not been up to the task. Doctors in Contra Costa County, California, reported that when their new EMS system came online, it was so slow that they had to cut the number of patients they could see in half.

Additionally, some in the health care industry are exploiting faults in the EMR system to engage in fraud. This offsets much of the system-wide savings benefits that policymakers were hoping to achieve by moving to a fully-digitized system.

On the other hand, there have been some advantages to going digital: Patients can now ‘reality-check’ their own medical records remotely, even by accessing them on an iPhone. And the pull-down template boxes may not be perfect. But at least they are readable. The illegibility of written orders and prescriptions is a major contributor to medical error.

Nevertheless, digital systems are here to stay. Early-generation tools are now being phased out, and new software and hardware packages are much better than their predecessors.

Attitudes towards the great march forward in electronic medical records within the industry are mixed, writes Dr. Eric Mitchell: “In 2011 a study of physicians show that 39% thought EMR would be helpful, 37% didn’t know if they would be helpful and 24% believed that EMR’s would hurt the doctor-patient relationship.”

The potential for improvement, though, is huge. The number of hospital deaths due to medical errors is now between 44,000 and 100,000 per year, making medical error the 6th biggest killer in America.  If EMRs are successful at reducing human error, we should see that number decrease substantially. Costs in direct billing and indirectly through insurance premiums are buffeted by many factors that have nothing to do with EMRs, so it is very difficult to look at that data and come to a conclusion.

If EMR is working, then the medical error death rate will be the proof of the pudding.