ELECTRONIC MEDICAL RECORDS: DISADVANTAGES IN THE EXAM ROOM May 10, 2010
Posted by jaxncmd in EMR in the Exam Room.Tags: electronic medical record, electronic medical records, EMR, exam room, physician
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As you can probably gather from the fact that I am writing a blog on electronic medical records, I believe that electronic medical records represent an important advancement for the practice of medicine. I feel that electronic medical records offer far more than simply legible transcription of the patient encounter, and instead, can be an extremely useful tool that enhances the patient visit. That being said, however, there are currently some major disadvantages to electronic medical records that can make using an EMR system so frustrating that it feels like a colossal waste of time and money. In particular, there are two major disadvantages that can dramatically affect the physician’s performance in the exam room.
The first major disadvantage with using an electronic medical record is that currently the information regarding a patient’s medical history at some point needs to be manually entered into the record system. The exact technique for entering this information into the patient encounter varies depending on the software used for the electronic medical record system – some systems allow patients to enter their personal medical history through a computer interface or Web portal, others use an optical readout that is filled out like an SAT test, and still other systems need a person to physically enter the data. Ultimately, however, the information must get inputted into the EMR and therefore the information available is only as useful and complete as the information that is put into the system. This means that if a patient forgets to tell you about their hypertension, or forgets the name of the “blue pill” that they take or what it’s for, then the EMR is useless for some of its benefits such as evaluating for medication interactions or reactions. While this problem is not a new issue in the doctor-patient encounter, it does significantly detract from the usefulness of electronic medical records. After all, if you put “junk in”, you will always get “junk out”, and in medicine this is not an acceptable practice as potentially this kind of “sloppiness” can be life-threatening.
Hopefully, in the future, once electronic medical record systems are the established standard and “everyone has one”, then this kind of problem will eventually be resolved as the patient’s medical information from their previous medical encounters and care will be universally available and will simply be imported from other systems. Until that time, however, this is unfortunately a significant impediment that physicians need to keep in the “back of their minds”, even if they feel that their EMR system is fairly accurate and complete. As a provider, you should still ask the patient for any previous medication problems, such as reactions with antibiotics, and always review their history when they return for a visit for any new changes.
While this first disadvantage is more of a “derivation” of a limitation that has always been present in medicine, the second major disadvantage is an entirely new problem that is specific to electronic medical records. This problem can be so significant, and such a major source of frustration, that it can almost make you want to throw your EMR out the window. To further compound this disadvantage, it is a problem that affects all EMR systems. The simple fact is that if the EMR system is not working then you may not be able to see patients in the exam room. If there is a software problem, the power is out and the computers won’t work, or the network is down, then you will not have access to any of your patient information. Depending on the nature of your practice and the type and purpose of the patient visit that is scheduled, then you may not be able to provide care for the patient on that day. For instance, if the patient is returning to review test results, this information may not be available because it is stored in the EMR. Another example would be an extremely complicated patient with multiple medical problems and multiple medications who is stable, but requires changes to their medications, additional medications for other problems, and the patient naturally did not bring their medication list with them. In this situation, it may be extremely difficult to provide safe or satisfactory care for the patient without access to their medical record.
In the past, when physicians had paper charts, typically the only time that “loss of access” to patient information occurred was if the chart was misfiled. Typically, this problem could be resolved within a very short period of time with some vigorous clerical work, and the patient was still able to be seen that day. There was simply a short delay before the physician was able to go in the exam room and see the patient. Typically the only other instance when patient information was “lost” was if the chart itself was lost or destroyed, such as in a fire, in which case you probably would not be seeing patients in the office anyway because of the fire.
With electronic medical records, however, any “computer glitch” can potentially destroy your entire charting system. Any “little” software problem, such as a computer virus or malware, can potentially eliminate your entire EMR. These computer problems, therefore, can potentially leave you feeling held hostage by your EMR system and actually keep you out of the exam room and prevent you from seeing your patients. Unfortunately, with the way that the current entire system for doing electronic medical records is structured, this problem will continue to be present. It therefore makes data backup, software management, and hardware and network maintenance extremely important components in electronic medical records, both for today and for the foreseeable future. Surprisingly, this is not a topic that the electronic medical record systems vendors, the government, or other EMR “experts” typically discuss. Ironically, this very post was actually delayed for a few days because of a software glitch that I was experiencing with my own computer system.
I hope that by pointing out these disadvantages that it will be beneficial to providers so they will realize that they are not alone when they experience these problems. For providers who do not currently have an EMR system, I hope that by making them aware of these limitations that they will be better prepared, and hopefully less frustrated, when they experience these issues as they move forward with an EMR system.
Now that I have discussed some of the issues surrounding electronic medical record systems in the physician’s exam room, I will next start to explore the impact that electronic medical record systems can have in the financial office of the medical practice.
ELECTRONIC MEDICAL RECORDS: ADVANTAGES IN THE EXAM ROOM May 6, 2010
Posted by jaxncmd in EMR in the Exam Room.Tags: electronic medical record, electronic medical records, EMR, exam room, physician
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The electronic medical record has the potential to offer many advantages to the practicing physician. These advantages include benefits related to the documentation of the patient encounter, access to the patient’s medical record and history, and assistance in formulating and delivering a treatment plan for the patient.
Some of the advantages can be realized today, as soon as the physician starts using the electronic medical record system in his/her medical practice. Other advantages, however, are more “theoretical” potential benefits that will either hopefully be developed as the technology matures, or will only be realized once the entire healthcare system has been transitioned to electronic medical records.
One the most obvious advantages that an electronic medical record system offers is a complete, well-documented patient visit. The EMR can allow a complete and very thorough documentation of the patient’s past medical history, including medications and allergies. It can also help create a very thorough history of the present illness, and one way this can be achieved is by providing extensive questions for the patient regarding their symptoms, potentially even prompting the provider for additional information based on the patient’s complaints. By utilizing the computer to document/transcribed all of this information, this creates a very clear and legible record of the care provided to the patient.
The EMR system can also allow for quick access to the patient’s medical records, such as a record of the patient’s previous visit, the results of prior studies that have been performed, correspondences regarding the patient, and notes regarding previous surgeries and hospital admissions. By having this information cataloged in an electronic format, access may only take a few clicks of the mouse/pen rather than sifting through a “telephone book” size traditional paper medical record. This would hopefully create more time for the patient with less time spent looking things up.
A very important advantage that the electronic medical record can and should offer relates to medication management. Specifically, this advantage relates to the evaluation of prescribed medications for potential interactions and adverse reactions that could occur due to the patient’s current medications or medical problems. Electronic medical record systems can also allow for e-prescribing, so that providers no longer have to fill out a paper prescription. The EMR system can also potentially help the healthcare provider in formulating treatment plans based on the patient’s diagnoses, perhaps by referencing established treatment algorithms for diseases.
These advantages only represent some of the most basic benefits that physicians should be able to realize once they start utilizing electronic medical records. Most of the advertising from the EMR companies already highlight these benefits, but hopefully by listing them in more straightforward terms, this will remove some of the “marketing clutter” and help reveal that, at its most basic level, the EMR system can be a very beneficial and practical tool.
I realize that some of this information may seem rather basic for providers who are already utilizing, or have experience with, electronic medical record systems. Since there are a large number of providers, however, who currently do not have an EMR system, I have decided to initially start my early posts on this blog by assuming that my readers do not have any experience with electronic medical records. I am therefore covering topics related to EMRs from the most basic level, and then moving forward, to help my fellow providers as they investigate and consider moving forward with electronic medical records, particular since there does not appear to be many other independent sources of this information currently available on the web.
Now that I have discussed some of the advantages of the electronic medical record system, and it sounds like a fantastic tool to help the practicing physician, I will be honest that there are also important disadvantages to electronic medical record systems, and I will review some of these disadvantages tomorrow.
EMR IN THE EXAM ROOM May 5, 2010
Posted by jaxncmd in EMR in the Exam Room.Tags: doctor, electronic medical record, electronic medical records, EMR, exam room, physician
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Although there has been a lot of discussion regarding electronic medical records, there has been little comment on how the EMR will fit into the practice of medicine from an “in the exam room” practical standpoint. It appears to be assumed that doctors will simply start using electronic medical records and that the only real issue is getting them to choose a system and move forward with implementing it. Unfortunately, the biggest issue for doctors moving to and accepting electronic medical records may in fact be figuring out “what to do with it”.
While it may be helpful to think of an EMR system as simply “another tool” that physicians can use for the treatment of patients, it is not entirely clear how and when this tool is to be used. There is no clear and well-defined protocol that is recommended for maximum utilization of the electronic medical record systems. While many of the EMR vendors make recommendations regarding the use of their systems, the bottom line is that every doctor needs to incorporate the EMR system based on his or her own personal practice style. Unfortunately, our practice style/bedside manner is something that we develop over the course of our training, but it is not something that we necessarily analyze and define, or necessarily even think about in terms of technological utilization.
No matter what your practice style, however, having an electronic medical records system will definitely have an impact in your exam room. How the system is used in the exam room, however, is open to significant personal preferences and individual styles. Some physicians prefer to have the computer in the exam room so that they can enter the information while they are face-to-face with the patient. Other providers, however, prefer to have the EMR system in their office, or in a central office area outside of the exam room, so that they can enter information after they have finished seeing the patient. Yet another option is to have a “scribe” follow and stay with the physician in the exam room during the patient’s visit, and it is this person who enters the data into the computer system. Clearly, all of these options in large part depend on the individual practitioner’s style of interacting with their patient, their level of comfort with the technology, and on the size (and type) of their practice. For some physicians, these options may simply represent a minimal alteration to their current practice technique. For others, however, it may represent a completely foreign “patient encounter” and require them to totally change their practice style.
As we start to consider the advantages and disadvantages that the electronic medical record system can have in the exam room, the discussion obviously starts with the individual practitioners established practice style. As I discussed above, for some physicians, the EMR may seamlessly fit into their practice style and therefore the transition may actually represent an advantage in itself. For others, however, bringing the EMR into the exam room may represent a revolutionary change for them and therefore the transition will be a massive disadvantage. It is therefore very important that you consider your practice style when you are looking at electronic medical record systems. If you have an idea of how you want to use this “tool”, then you can have the EMR fit into your practice, rather than having to change your practice to fit the EMR.
Tomorrow, I will start exploring some of the clinical advantages that the electronic medical records system can have on your practice.
