Monday, June 20, 2011

Drawbacks of the Electronic Medical Record

For those who did not have the opportunity to read the News-Herald article I wrote on the electronic medical record, I am posting it here.

            As a diabetes specialist and endocrinologist, I ask what is the evidence to support this treatment compared to other therapies? When I supervise clinical research studies, I do so with strict attention to protocols designed to answer the question: how safe and effective is the drug being tested compared to other treatments? 
            Sadly, policy makers in Washington never demand answers to similar questions when they pass laws that affect millions of lives and cost billions of dollars. The best recent research shows no convincing evidence that use of an electronic medical record (abbreviated EMR) improves care or saves money. And implementing EMRs will introduce hidden and unknown human costs.

            More and more physicians use EMRs because large networks like the Cleveland Clinic or University Hospitals require them. If you went for a check-up recently you may have had to compete with the computer for your doctor’s attention. Most EMRs have templates that require physicians to tick off boxes or fill in blanks. But people do not speak in templates. The flow of the patient’s story can become lost as the doctor stares at each EMR screen, typing to complete each section.

            Physicians who focus on procedures, like surgeons and surgical subspecialists may be less troubled by EMRs. But many physicians find that the EMR detracts from active listening. A patient’s story and life situations are always important in evaluation and treatment. Good listening is at the core of therapy for family practitioners, cognitive specialists like endocrinologists, psychiatrists, and others. Many physicians with whom I have spoken wish they could return to paper charts. They describe their EMR as cumbersome, user-hostile, time-consuming and dehumanizing. They say they wouldn’t use an EMR if they had a choice.

            Despite these concerns, the federal government has set aside over $19 billion of taxpayer money to help implement EMRs. Big businesses like General Electric are expecting to profit as they sell their versions of EMR to doctors across the country.  Most EMR reports from an office visit are 10 pages or more of unreadable gobbledygook with no paragraphs or complete sentences.
            And a recent survey showed a majority of physicians were concerned that an EMR would require they see fewer patients and would be costly to implement and maintain.  These views explain why adoption of EMRs has been slow.
            In response, the feds now offer a modest annual bonus to those physicians demonstrating “meaningful use” of an EMR for their Medicare and Medicaid patients. The Center for Medicare and Medicaid Services (CMS) has defined “meaningful use” in a recent 276-page document; CMS can change this definition whenever they like. By 2015, those practices failing to comply with EMR requirements will be penalized a percentage of their Medicare charges.

            I question why such bonuses and penalties are necessary if EMRs really improve practice. No one needed government incentives to start using computers or smartphones. Along with many others, I share the concern that an EMR is open to breaches in privacy and exposure of confidential data by hackers. And with EMRs, patient care comes to a halt in the event of a power outage.           
            I am also concerned that the implementation of EMRs has been haphazard. There is a lack of standardization. No two EMRs are the same and they cannot interface with each other.
             In my practice, I dictate each office visit after the patient is seen. The transcribed note is promptly printed out and sent to the patient’s primary doctor. Each note tells a confidential, readable, human story.

            As technology improves, future EMRs may be more humane. At present, I will not implement an EMR until its benefits are clearly shown. In the meantime, I am prepared to pay government penalties for the privilege of listening to and caring for my patients.


  1. ...and that is why you are the best!! Seriously, I am always so amazed at how much you remember about me when I visit you after a year has gone by.

    You make some really good points in this article and I appreciate you sharing that and making us aware of the downside of EMRs. I would have never even thought about that.

    Thank you for taking an unpopular stand and sacrificing for the sake of your patients and your own personal standards. I truly appreciate it.

  2. Thank you for your supportive and kind comments.

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  4. Thank you for your kind comments Mr Kelvin. See for valuable insights on health care in general. You will note that few of my posts are political.