A patient came into my office the other day complaining of chest pain. This is a serious symptom that needs to be evaluated fully so as not to miss a serious causes. While he was in the office, I was quickly able to access his last cardiology note including recent stress test and echocardiogram along with his most recent labs and xrays through my EMR (Electronic Medical Record or computerized records system). I was able to rule out many serious causes with the access I had to his health record at the tip of my fingers. I did an EKG in the office and was able to access his last one and compare it. It turned out to be nothing serious but if needed I could have even ordered lab tests which I would have had access to as soon as they were available through a push notification on my phone from my EMR’s mobile app. This is merely one instance but it highlights just a few of the advantages with incorporation of EMR technology into mainstream medical practice.
I have always been a fan of technology and the power we are able to leverage when we incorporate it into our lives. Just look at that cell phone in your hands and all that you are able to accomplish with it. In the time it takes me to walk from my car into my office I can check my email, scroll through some facebook posts, see if my team won the game last night and know the weather for the day. When this technology is used in medicine its benefits can be amazing. Things I simply cannot know, such as obscure interactions between medications, are readily available.
Despite the benefits of an EMR, there are still doctors that choose to hold out and refuse to move into the 21st century. In an online webinar I attended last month on how to work cooperatively with my EMR, I was shocked when one of my physician colleagues was proud of not converting to an EMR and therefore avoiding some of the “hassles” with it. Some doctors are perfectly satisfied writing out their notes and keeping physical charts that take up the space of a small closet.
Reasons cited for holding out include: time consuming note entry, interference with face to face care, lack of computer skills to maneuver through an electronic chart and expense, among other complaints. Some older doctors have even retired when faced with the possibility of converting to an EMR. I am not going to lie, the above concerns are valid. Computers can and often do take away from a patient interaction. It is harder to type than write (for some people). EMRs are very expensive.
Here’s the thing though: Medicine has progressed into a digital age and it’s not going back. The future of medicine will move closer and closer to an all computerized paperless system. The doctors that refuse to hop on this train are going to become irrelevant and disconnected from patients in an increasingly online and computer based society. According to dashboard.healthit.gov, since 2008, office-based physician adoption of an EHR has nearly doubled, from 42% to 87%.
First, some background. The dramatic increase in EMR adoption was mostly because of a program called Meaningful Use as part of the American Reinvestment & Recovery Act (ARRA) in 2009. While this program promised cash incentives to help offset the cost of EHR adoption, the metrics to meet were often confusing and difficult to access with some EMRs. Many doctors and practices adopted EMRs without receiving the incentive.
As of earlier this year there were about 1100 vendors that offer an EHR. Many of these are start up companies trying to get a piece of the EMR pie that promises big returns as the medical community becomes more digital. Many of these EMR vendors are unfortunately not in a place keep up with the mounting regulations that are being placed on EMRs and in the future will be bought out or go out of business. According to Medical Economics magazine, 26% of doctors doubt their EMR vendor will be in business in 5 years.
So where does this leave us? The Meaningful Use program is no longer active, but it has left us with a more widespread adoption of EMRs (which in my opinion is a good thing). It has crossed the point of no return. The future will see consolidation of a lot of these EMRs and there will likely come a time when having an EMR will be federally regulated and mandated to participate in certain insurance programs and Medicare.
How do we solve the concerns voiced by the holdouts? First, the doctors that are holding out and still using paper are still good doctors. We just need to provide a way for them to incorporate into the electronic record keeping system as easily and pain free as possible. Incentives should be given to offset the cost (with easy to attain goals for using an EMR). Data entry needs to be made easy and not time consuming through the use of a scribe or transcription. Classes need to be offered on how to properly navigate an EMR and use it cooperatively while minimizing any negative effects on patient interaction. All of these things have been mastered and are done daily by other EMR users. We need to rely on their expertise and expand it to all.
Lastly, how does this affect patients? With increasing adoption and interaction between EMRs, the patient will definitely benefit. Having access to more information on a patient is always a good thing. We can avoid the serious consequences of medication interactions and know medical histories to enlighten our medical decision making. We can avoid repeating vaccines or tests when they have already been done and decrease costs. We can have immediate access to other physician and hospital notes to know about their decision making and why certain medications are being used. The benefits are numerous. Yes, there are some minor drawbacks, but hopefully these have been or are being worked on. So if you are a patient reading this, choose a physician that uses an EMR. If your current doctor doesn’t use an EMR, encourage him or her to start. If he or she does, then be thankful for all of the benefits (seen and unseen) that it is providing in your medical care.