The Electronic Medical Record
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
Like it or not, we live in a time when technology is rapidly advancing. Information technology has become a huge part of healthcare in the last 10-15 years. The electronic medical record, or EMR, is changing the way providers deliver care and the way patients receive their care. This has been especially on my mind this last week as Community Health Network is transitioning to a new and improved system. This has been a huge undertaking demanding millions of dollars and many hours of training. Why is all this time and money being spent?One major factor that is driving the implementation of the EMR is that the federal government has mandated it. This is being enforced by requirements established by the American Recovery and Reinvestment Act of2009, which you may remember as the “stimulus package.” This bill allocated 155 billion dollars to health care with almost 26 billion targeted at driving all healthcare providers to use an EMR. As of Jan 1, 2014 all health care systems had to demonstrate that certain functions in the delivery of health care were being done electronically. If this could not be demonstrated, reimbursement for Medicaid and Medicare services would be reduced. The types of functions that need to be demonstrated include placing orders, prescribing medications electronically, and documenting medical history and diagnoses in an electronic form. So, one answer to the question of why the time and money is being spent is that the law requires it.
But, the other reason is that there is the potential to significantly improve the delivery of health care. A medical record that is stored in an electronic data base can be accessed at any time of the day or night and would require only a computer that has access to the internet.
The goal of the EMR is to improve quality, safety, and efficiency of health care delivery. This could be accomplished with records that are accessible, accurate, and current. Providers could be alerted to current standards of care based on diagnoses. Also, these records would be available when patients need care on an emergency basis or when they see multiple providers. By having accurate records of medication allergies and current medication lists, the chances for medication related problems would be reduced. Medication interactions and allergies would be alerted as the prescription was being generated. Also, an EMR has the potential to allow patients to be more active in their health care. Patients could access results, get information about their condition, request refills, ask questions of their provider, and even schedule an appointment electronically. The goal would be to have all this happen with preservation of patient confidentiality.
While all these goals are desirable, the implementation and delivery of an EMR that meets all these goals is not as easy as it may sound. The software and hardware required to make this happen needs to be constantly upgraded, requiring a team of information technology specialists and expense. Healthcare workers need to be trained to use the system. This can lead to inefficiencies and frustrations during the transition time. Also, the system still depends on the information being entered into the system to be accurate. Another challenge is that different healthcare systems use different programs that do not always communicate. Also, it seems that no matter how many possible scenarios are in the program, there seems to be exceptions that do not fit the program because patients are unique and have unique circumstances. Hopefully, these bugs can be worked out since the EMR is here to stay.
Through the affiliation with Thedacare, CHN has gained access to an improved EMR. Who knows where technology will take us in the future. I am hopeful that the goals of the EMR can be achieved without losing the aspect of the personal relationship that patients can have with their provider. Stay healthy my friends.