Potential pitfalls with electronic medical records

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Potential Pitfalls With Electronic Medical Records Published in West Virginia Medical Journal, March/April 2007, vol. 103 Carrie L. Fitzgerald, Can Talug, Stanley Zaslau


Introduction

EMR systems have the “potential to improve quality of care, physician and practice efficiency, and accessibility of stored medical information,” but these benefits do not come without challenges in the form of “finances, functionality, accessibility, as well as skills necessary for utilization and potential for data loss.” The article delves into each of these areas in detail so as to “provide further insight into the challenges encountered by those implementing EMR systems.”

Methods

There was no indication of any formal methods leveraged in the creation of this article. It is an informational piece relying on citations of other published material.

Findings

Despite the aforementioned benefits of EMR, the paper points out that “only 25% of non-military, non-Dept. of Veterans Affairs are using electronic patient records” (1). The paper then highlights some common reasons for the difficulty in implementing EMR applications.

One area of challenge is that of accessibility. It is noted that particularly at the bedside, paper and pen are frequently more accessible and hence more efficient. In contrast, access to computerized records is made difficult, less convenient by the requirement for password protection. Worse yet, this creates the possibility for password expiration and consequent lock out from the desired data. There is also the issue of physical accessibility; computer terminals are not always available where they ideally would be needed. One can think of the operating room environment, where a non-accessible or perhaps a non-functional computer would not allow access to chart information that is only viewable in electronic format. This in turn would lead to “potential difficulties in rendering surgical care as well as difficulty in obtaining important information about the patient before and during surgery.”

Another area of challenge is that of finances. Even with Medicare offering to provide the Vista system free of charge, installation costs can be thousands of dollars; some suggest that the cost can be as high as $10,000 (3).

Then there is the issue of skills required to utilize an EMR system. Physicians who are not sufficiently tech-savvy may undergo very steep learning curves, thus contributing to increased office visit times, “ultimately limiting patient loads per physician and increasing wait times for other patients.”

We can also consider the issue of interoperability, intercommunication, data sharing. “Most non-inclusive medical practices need to be able to data share with pen and paper and the outside EMR world,” but this may not be possible if two parties are not equipped with the same EMR product (4). And in cases where intercommunication is a possibility, it often comes only after substantial optimization, troubleshooting, and ongoing technical support (5).

It is pointed out that the choice of vendor is a crucial one; a wise choice can help alleviate some of the aforementioned difficulties and the recommendation is made that written customer service agreements and support contracts be signed in advance of the sale, and set-up costs should be included.”

Regarding the claims that EMRs improve efficiency, the paper mentions that “in each of the last six years, CIO Insight Strategies for IT Business Leaders, has put EMRs to the efficiency test—they were given seven minutes to prove EMR was faster than pen and paper and lost 6 out of 7 times” (6).


Discussion/Conclusions

The authors conclude by acknowledging that as with advances of any technology, there are potential pitfalls that are created. While EMRs are a rapidly growing strategy for clinical documentation—offering the potential improvements in patient care, physician workflow efficiency, and availability of medical information—continual process analysis and education of health care professionals are required to adequately address the consequent deficiencies.


Comments

The article takes a frank perspective in its stance to temper all the hype surrounding EMR benefits with a candid discussion of the practical difficulties that can hinder successful deployments—namely with regards to accessibility, economics, usability, interoperability, and efficiency. All of the points made with regards to these areas of challenge are I believe worth reiterating; but, I believe that most of those in the EMR community are already painfully aware of these items. While the authors do indicate that things such as choice of vendor, process analysis, and clinician education may alleviate the difficulties, I thought the piece would have been stronger if it made more detailed mention of some of the success factors that have perhaps been associated with successful deployments. The piece appears to have been an informational article, providing some high-level descriptive information of primary interest to those relatively new to the topic of EMR implementations.


References (recreated as per the article’s original listing)

  1. Kolata G. U.S. will offer doctors free electronic records system. New York Times. July 21, 2005. NYTimes.com. Accessed September 19, 2006.
  2. Frist B. Medical records remedy. The Washington Times. August 2, 2006. WashingtonTimes.com. Accessed 9/19/06.
  3. Cayabyab E. Medicare to provide free electronics record system. Ars Technical. July 27, 2005. Accessed September 19, 2006.
  4. Reider J. Technology in your practice: the electronic medical record: promises and pitfalls. Med Scape. July 25, 2003.http://www.medscape.com/viewarticle 460247.
  5. Meyers JS. Electronic medical records: 10 questions I didn’t know to ask: buying an EMR system? No matter how great it seems to be, get good answers to these questions before you buy. American Academy of Family Physicians News and Publications. www.aafp.org/fpm/20010300/29elec.html.
  6. Baker ML. Contest pits electronic medical records against pen and paper. Ziff Davis Internet. CIO Insight Strategies for IT Business Leaders. May 19, 2005. Accessed

September 19, 2006.