The New Sliced Bread, EMRs, Web Medical Records.
Information technology (IT) specific to healthcare has become a hot item on a national scale as well as in the international healthcare community. It is safe to say I think that the electronic medical record (EMR) has come of age and before long all healthcare organizations will be utilizing various software platforms to document clinical findings, patient hospitalization courses, and a host of other patient related items that are now done with ink and paper. Healthcare IT will clearly ensure software engineers job security well into the future and will open several doors for clinicians desiring to make the transition from the bedside to a desk.
The opportunities with respect to the implementation of IT in healthcare are somewhat reminiscent of the dot com area of years gone by when fortunes were made and quickly lost. Even the software giants, Google and Microsoft have entered the healthcare IT arena attempting to garner the attention of healthcare organizations and patients with their respective web based healthcare record systems. Some industry leaders, experts, etc. are tooting these web based record systems as the “latest and greatest” in terms of medical record storage. Claims of improved patient outcomes and improved quality of care delivered as been miraculously attached to the use of healthcare IT. While the medical community is all a dither in this wave of technology I think we must take a moment of pause and look at these various systems and determine exactly what benefits are realized from the use and implementation of such computer based platforms before we just rubber stamp the go ahead on such a large capital investment, especially during this time of fiscal hardship that healthcare is enduring.
Electronic Documentation/Electronic Medical Record (EMR): I for one am a fan of electronic documentation for many reasons. Legibility, accountability, and an equitable distribution of workload with respect to documentation between all healthcare providers are the top ones. Coders like the electronic documentation because it increases billing rates and if used properly it will improve reimbursement rates from payers, which increases an organization’s revenues.
Some of the downsides of electronic documentation include the time it takes for some providers to accurately complete documenting. Let’s face it not everyone is computer literate and have not developed good typing skills. In some settings there are real-estate issues with respect to the added computer assets that are needed to implement an EMR which can be a real problem in some departments, such as crowded emergency departments. Depending on the systems in place at hospitals, developing functioning IT interfaces can be challenging. To take already established software platforms and marry them to new EMR software is not always an easy task. Finally the cost associated with these systems is nothing to sneeze at. These systems (EMRs) come in many shapes and sizes and have a multitude of options and the sales reps have an endless list of upgrade packages for an additional fee and lots of promises of “yes we can do that”…”we just have to get with our software people and build the patch”. Some of these folks I think used to work at used car dealerships. In the end, cost and functionality drive the decision making process for most organizations.
Web Based Health Record and alike: Google and Microsoft have jumped on the band wagon with their respective platforms Google Health and HealthVault; a free service (for now) for organizations and patients to upload their medical information to the infinite cosmos of some server somewhere. Critics have voiced their concerns with the privacy of the information; others have haled this new capability as the new sliced bread. A few bloggers I have seen have the same question regarding these web based EMRs that I have. Who is really going to use this information? How is it going to be accessed, updated, verified, etc? I suspect not too many providers are going to be looking at a patient’s EMR on Google or HealthVault.
Other organizations are making CDs of patient’s health records and giving it to the patient to be used in an emergency situation. Claims of improved patient outcomes have been forecasted with this type of medium. I don’t see how patient outcomes will improve as a result of a CD, but more relevant is the fact that the CD must accompany the patient to the hospital for it to be of any value. In an emergency it is not likely that the CD is going to be in someone’s pocket, wallet, or purse. Additionally this type of EMR is time sensitive. The CD would need to be updated as the patient’s health information changed. “Hold on, I need to get the right CD, I think this is the updated one….”
So what is the point to all this. EMRs improve documentation and reimbursement. It is also likely that some medical errors will become mitigated as a result of EMRs. That being said, there is the chance of additional errors in provider order writing when incorrect keys are punched when entering orders using an electronic system. For example I have seen simple errors that were not caught initially when an ER physician ordered 75 mcg of Demerol (narcotic pain medicine) when the order should have been 75 mg. The two values were in a drop down menu underneath each other in an electronic documentation system. Like many thing in life paying attention to what you are doing is important.
Clearly the implementation of EMRs I think is valuable and will continue. The fact that healthcare leaders and others make claims of improved quality of care and better patient outcomes is a bit presumptuous with respect to healthcare IT. Clearly technology offers many adjuncts in healthcare that improve our ability to care for patients but in the end good quality healthcare with good patient outcomes can really only be associated with good work ethics, genuine caring by all providers, doing what is in the best interest of the patient, and adhering to current standards of practice through the use of evidenced based medicine. EMRs and healthcare IT does not keep a provider from being sloppy or incompetent.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
