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The failure of the electronic medical record (EMR)

bad EMRsIt’s been a few years since we’ve begun to install and adopt (sometimes begrudgingly …) electronic medical records (EMRs) into our hospitals, clinics, and lives. And now that these systems are being used more widely, have they really given patients and doctors all the promised benefits?

The promise

From a patient’s perspective, the ideal EMR would allow any doctor’s office or hospital you walk into to have instant, easy, and complete access to all of your doctors’ notes, lab results, current and past medication list, drug allergies, medical imaging reports, and more. This would allow the MD that was seeing you to quickly learn about the current status of your health and allow the doc to help you with your current issue as effectively and efficiently as possible. Furthermore, the ideal EMR would also talk to all pharmacies for error-free e-prescribing and all the insurance companies for error-free billing. This is the promise of the EMR.

The reality

Even though many hospitals and doctors’ offices have EMRs installed,  the systems don’t talk to each other. For example, I work at two hospitals that are physically connected. You can begin walking down a hallway in one hospital and find yourself in the second hospital without even knowing it. So you’d think that you’d be able to get the same information about one patient if you were looking at their EMR in Hospital A or their EMR in Hospital B. This is not the case. Why? Because the administrations of the two different hospitals decided to purchase two different brands of EMRs. This is madness.

OK. Maybe you think I’m unreasonable for wanting EMRs of different vendors to talk to each other. Well I also work at an outside clinic (Clinic C) that has the same EMR system as Hospital A. So am I able to see all the lab results drawn at Hospital A while I’m seeing the patient at Clinic C? No. Not without having to log into a separate area of the EMR. More madness.

What does all this poor UI lead to? Tests being repeated, the same prescription medication being ordered multiple times, patients inconvenienced, wasted time, and wasted money.

My dream

Forget the fact that most EMRs out there are clunky, have poor UIs, and cause repetitive stress injuries for the MDs and support staff that now use them. I can live with all of that for now (knowing that technology will improve over time). What needs to change; however, is the non-communication between EMRs. The entire reason to have EMRs is to share information and right now, they don’t share information!

A doctor should be able to open a chart and see a diabetic patient’s entire record of blood glucose lab results on one page, regardless of what lab they were performed at. We should be able to see all measurements of a hypertensive patient’s blood pressure on one page, regardless of what clinic or hospital it was measured at. Anyone who has even thought about this issue should realize that this is an essential feature of a successful nationwide EMR system. This is a no-brainer here, but for some reason the EMRs we use cannot do this.

Solutions?

The healthcare industry cannot solve this problem because it is an industry. There will always be competing EMR companies that don’t want other EMRs to see information in their system. Healthcare systems also cannot solve the problem. They might not want to share patient information because they think they might lose revenue. It can’t be too easy for a patient to switch doctors…

I believe the solution has to be mandated by law. Four years ago, I wrote President Obama about this very problem (of course, I never received a reply or invitation to discuss this issue further). The entire country should use the same EMR system and it should be seamless. The data should be blended into a continuous feed for the providers to use to help their patients. MDs and RNs should not have to log into different areas within the same EMR to access information from different sites.

If the goal of EMRs is efficient and effective healthcare, then we are still way off mark.

I welcome your viewpoints and ideas. Please leave a comment below.

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(Photo credit: freedigitalphotos.net)

 

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2 comments on “The failure of the electronic medical record (EMR)

  1. Elliott S Wolfe
    November 6, 2012

    Dr. Leng’s analysis is correct about the EMR. There is more besides lack of connectivity, which he alludes to. EMRs in general are too long with excessive data repeated over and over again. However, they are readable, though not always in precise English. When used with finesse and organization they are a superb improvement over the past. I believe medical students should be formally taught how to use the EMR early in medical school. Current users can create innovative methods within an institution for streamlining. One final point — errors in recording the physical examination are easily perpetuated; caution is paramount. EW

  2. Pingback: How to Have Your EMR Cake and Eat It Too: Discrete Data Capture iData Blog

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