Electronic Medical

Records:
Benefits, Drawbacks, and the Like

4/26/2011
MIS 290, 8-9:15 a.m. TR
Group 2:
Adam Kirby
Amy Moses
Kate Shamblin
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EXECUTIVE SUMMARY:

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BODY:

EMRs, or electronic medical records, are prevalent throughout the medical industry and

are used to easily store and access patients’ medical information. The world – very much

including the medical industry – is venturing from the paper medium toward a more

technological form of communication and task completion. Naturally, electronic medical

records will become widespread in a very short period of time.

In our opinion, there are a majority of benefits; however, there are a few details about

EMRs that must be considered. A few of these draw-backs in regards to electronic medical

records include: a costly implementation, the ease of accessibility, and a lacking of

interoperability.

As aforementioned, there are some advantages to converting to the use of electronic

medical records. Some of the short-run benefits to implementing EMRs deal with space saving,

an ease of alteration, ease of accessibility, and the information is in a centralized location.

Our group shares an interest in this subject matter because it will affect every member of

society, from every class and creed. The implementation of electronic medical records is
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advantageous both of in the short-run and the grand-scale of the progression of society. It will be

far more effective and efficient than maintaining previous paper filing methods, and will benefit

both the physician and the patient in a plethora of ways.

For years, hospitals have used countless pieces of physical paper, folders, and file

cabinets, to store a prolific amount of patient medical records. Advancements in the computing

world, however, now make it more logical to replace notepads with laptops, and file cabinets

with hard drives. The use of electronic medical records is actually improving patient care.

Patients are not the only ones to benefit; using electronic records makes it easier for nurses or

doctors to record what is being done for the patient. In addition to this, electronic records also

help to reduce operating costs. These three reasons are incentives worth taking advantage of.

Now we begin the in-depth discussion of these incentives. In many hospitals, the adopted

credo is that the patient is always right. This frame of mind is used so that the patient always

receives the best care possible. If sticking with this motto is important, then we must ask

ourselves if electronic medical records improve patient care. The answer is yes. By their nature

EMRs make it easier to care for patients, giving care providers more opportunity for positive

results. For example, programs like Vista, allow doctors to immediately pull up scanned

documents, or other images like x-rays, while in the patients room. Doctors are also able to

review formatted notes that list specific problems with their patient. Along with providing

information on a specific patient, EMRs are able to compile large amounts of data, which proves

extremely useful for showing certain trends – throughout the region, within demographics, or

potentially even on a global scale – in care (Ferguson).

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The Veterans Health Administration, or VHA, is the first hospital to adopt EMRs on a

full scale. One example of success the VHA has had with the monitoring of cholesterol in

patients who have been victims of a heart attack. Monitoring a patient’s cholesterol is an

important part of keeping a patient healthy. However, even diligent hospitals sometimes neglect

to monitor this. In 2003, when the VHA was using EMR’s, 94% of patients were being

monitored for high cholesterol. Other hospitals though, only had 79% of patients being

monitored. Clearly the consistency of electronic recording can be beneficial (Ferguson).

The very essence of a hospital is to do good for others by helping them to live a healthy

life. Some hospitals even choose to be non–profit in order to accomplish this more fully.

However, this doesn’t mean that money isn’t important to them. With skyrocketing medical

costs, it is now more essential than ever for hospitals to be monetarily efficient. Though it may

seem insensible to implement an expensive EMR system when money is tight, it is a better

choice in the long-run for a medical provider. Studies show that over time EMRs end up saving

much more than they cost. A study in the American Journal of Medicine concludes that

providers saved on average $44,600 by switching to a medium level EMR system, and $84,600

by switching to a more comprehensive, full EMR system. So while EMRs may seem expensive,

they save on costs like billing errors, adverse drug effects, and charges for accessing other

medical databases. When it is all said and done, the switch to EMRs will reduce costs greatly

(American Journal of Medicine).

Because of the possibilities of EMRs, they seem to becoming more prominent. Of

course, any time computer-based technology is used, there needs to be some sort of software that

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goes with it. Needs can and most likely will determine what will be included in software. For

example at Meridian Health Systems in New Jersey, Becki Weber, the CIO, brought together all

the people whose jobs and duties mixed with one another. She did this to figure out everyone’s

specific needs, so that an EMR system could be built based on “varied roles and interactions.” In

fact, when developing the software, the developing team consisted of nurses, physicians, and

others, including those from finance and admissions. It is viable that the type of software needed

depends upon the needs and requirements of a hospital or family practice. The next question to

consider is why this is true. Weber sums it best when she said, “We found that nursing wasn’t

just about nurses” (Briggs). In other words, everything and everyone is connected, and that

should be reflected in the software itself.

Since this need based type of software is found in other places, let’s take a look at another

place where this type of software is used. Located in Washington, D.C., the Children’s National

Medical Center has also implemented a type of software that is based on what is needed, instead

of on something standard. In fact, they spent more than a year “researching electronic records

and assessing workflow needs.” With nearly thirty primary care facilities and remote clinics, this

specialty hospital has nearly 275 employed physicians, and the success of Children’s National is

the fact that the employed physicians participate with EMRs. To prove that claim, Kelly Styles,

the CIO at Children’s National said, “Our physician model is what makes the difference”

(Briggs). In other words, the specific type of EMR implemented there applies to what the

physicians need.

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The software is important for EMRs, or else no one would probably use EMRs. However,

there was a case study of a family practice in the Province of Québec, Canada that has given

EMRs a shot. Those who had chosen to use EMRs in this study had a generally favorable

attitude after just one year of implementation, and they saw many benefits from its use. Among

these benefits were, “direct and quick access to complete information about a patient, available

from various sites (clinic, hospital and home), and information sharing between professionals

working in teams.” EMRs were also seen as being key to the follow-up of patients because

different human factors, including nurses and physicians, among others, could respond to the

patient. Time saving was also reported. On a negative note, however, EMRs seemed to increase

the workload and cause teams to reevaluate work processes (Duplantie et al.).

Along with the actual success of EMRs in a family practice, it has been found that EMRs

can truly help in diagnosing ailments and improving care. More specifically, we take a look at

how an EMT based intervention helped with care for gastro-esophageal reflux disease (GERD).

GERD is many times undiagnosed and untreated. Often times, GERD can be diagnosed by

recognizing common symptoms, such as heartburn, but atypical symptoms, such as asthma,

laryngitis, and a chronic cough, make GERD harder to diagnose. However, EMRs can readily

have guidelines and education available for doctors and give decision support at point of care. In

this particular study of EMRs, the Medical Quality Improvement Consortium (MQIC) and the

model of the Centricity® EMR were used. There was both an intervention group (the group that

had a certain tool to assist in GERD and symptoms that represent atypical GERD) and a control

group. The outcomes: diagnosis of GERD, diagnosis of GERD for those who had atypical

symptoms, and prescriptions for GERD. Due to the EMRs, the amount of diagnosis and
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treatment of GERD in the intervention group was increased. However, it is important to

remember that there are certain limitations in this study, including notes put in EMRs that can be

underestimated. Even though the amount of improvements remained low, this study has shown

that EMRs are helpful in diagnosis of GERD (Chen et al.).

Some experts speculate that while the use of EMR’s may lead to more accurate records, it

causes disconnect with the way doctors think of individual patients. It is thought that if a doctor

is simply checking boxes and filling out standard questions, then he will not be able to form a

unique clinical thought process for that individual. M.D. Daniel Luchins sums this ideology up

when he says, “The more information that a clinician collects and records using these measures

(electronic recording); the less it is processed, tied to a specific individual and made part of a

narrative; the less that might be remembered by that clinician when they have to make a

decision.” Luchins goes on to insist that to fix this problem, emphasis needs to be placed on

finding out the quality of individual care rather than data and statistics. Most experts, like

Luchins, seem to agree that there are more benefits than drawbacks to EMR’s. As with any new

technology, it will take time to adjust properly (Luchins).

Various elements of human error can be found in the use of EMRs. The first thing you may

think of when considering human error, is simply entering something incorrectly into the system.

However, human errors can be made even in the software development of the EMR itself. These

human errors are very important to consider when human lives are at stake. One common

problem is that software designers may not fully understand the interaction that health providers
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will expect to have with the computer, causing general confusion and misuse. Another example

of a common problem is the incorrect selection of medications that may be spelled similarly.

Once again, these problems can be worked out. There is a push for EMR software to be

authorized by some sort of government entity, ensuring that it is a quality product to use when

patient lives are involved. Other solutions simply involve being diligent, insisting that healthcare

workers are thoroughly involved in the process of developing EMR software (Harrington).

In the paper for GERD diagnosis previously discussed, the authors wrote, “Future

initiatives may need to focus on a better understanding of barriers and facilitators to this

diagnosis” (Chen et al.). Within Bill Briggs’s article Electronic Medical Records: A ‘Workflow’

in Progress, he quoted Lucy Molfetas, director of information systems at the Medical Center at

Princeton, New Jersey, as saying, “We’re continually looking at it, making literally weekly or

daily adjustments” (Briggs). What’s the point of saying all these things? The point is that EMRs

are constantly a part of change and innovation to help improve the workflow and patient care of

those who use them. Hal Teitelbaum, M.D., said it best, “Progress requires attention and

innovation; standing still guarantees defeat” (Briggs). Innovation is key.

This leads us to pose the questions: where are EMRs going in the future and what more

will they offer? In a recent survey of Ontario doctors, it was found that doctors are becoming

more reliant on EMRs. If a doctor would have the EMR they need, they would adopt it and use

it. Within this survey it was found that 90% of doctors use EMRs regularly, 92% use them to

enter notes, 73% of doctors felt they are now mainly paperless, 53% use EMRs to remind them

of preventative or chronic care events, 83% use it as main source for information on patients,

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65% think EMRs improve quality of care, 84% think EMRs improve or maintain revenue, 79%

report improved or maintained productivity, and 87% felt that privacy improved or was equal to

privacy provided by paper records (Webster). The future of EMRs will be greatly impacted by

Congress and President Obama’s American Recovery and Reinvestment Act of 2009. This act

will provide financial incentives to doctors who use EMRs properly, and it will also penalize

those who do not use EMRs. Doctors who have not begun using EMRs by 2014 will have their

Medicare reimbursements reduced by 3% starting in 2015 (Madduri).

It is crucial to consider the staff that will be using the new technology. While

implementing electronic medical records, the nurses, physicians, and technicians must be close

to mind. The software introduced must be flexible enough to span across the wide range of roles

it must fulfill; however it must be concise enough to keep costs as low as possible, as the costs

are by nature expensive. Thus the selection of software implemented is an extensive

consideration at the very least.

With EMRs, the quality control is drastically improved. With this software, come a

diagnosis assistant, which helps pinpoint the cause of seemingly unrelated systems, such as in the

facilitated diagnosis of GERD we highlighted earlier. The statistics, opinions, and general

momentum of the world all point to one inevitable fact: technology is encroaching at an

increasing rate with each passing day. What is left for society to determine is whether to

embrace the advantages or remain wary of the draw-backs.

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