EMRs in the Real World

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I’ve been thinking a lot about EMRs (Electronic Medical Records) lately. Perhaps that’s because I’m interacting with an EMR for 10+ hours a day. Talk of EMRs is all over the news, discussed with health care reform, debated on blogs. A recent post on KevinMD also includes links to lots of other posts about EMRs. I’m no health information policy guru or medical economist, but I am a doctor who uses a comprehensive EMR and can see the pros and cons.

What do I like about the EMR?

  • If you’re a patient within the system, all your records are in one place. If you see your PCP, see a dermatologist, have a colonoscopy, get prescribed an antibiotic, have your cholesterol checked or call with a question about flu shots, it’s all there.
  • Medications are prescribed directly from the computer and faxed to the pharmacy. No more taking in a written prescription.
  • Labs and imaging results come to my inbox like an email as soon as they’re done. Nothing sits in a pile of papers.
  • *Can be accessed from home.

What do I dislike about the EMR?

  • #1, by far, is that MY EMR does not talk to YOUR EMR. What I mean is that patients who have a PCP at medical group A, specialist at medical group B, get labs done at hospital C will have their records stuck in 3 different EMRs which do not talk to each other. Patients don’t understand that I can’t log into a hospital across town’s records from my office computer. We’re not connected. We still have to FAX a signed release to another hospital or medical group to get a printout of your electronic results FAXed back.
  • A summary of a fully electronic office visit can look a little impersonal. I don’t think this will matter much to patients, but I miss the narrative of the HPI. It seems to get lost in a list of diagnoses and computer generated orders.
  • *Can be accessed from home. Great when you need info when on call. Nice to finish up charting later. However, the 24/7 access can make it harder to truly disconnect.

The days of a thick paper chart with handwritten notes seems so antiquated. However, they did have one major advantage. About a year ago there was some type of computer catastrophe and the EMR was inaccessible for several hours. We didn’t know what to do! There are polices and procedures in place for computer failures, but it really was amazing how paralyzed we felt when that little glowing screen that guides our lives didn’t blink back!


2 responses to “EMRs in the Real World

  1. Any concern about hackers? There’s so much concern over personal privacy in the medical field (justly so) so I wonder how to best secure the EMR.

  2. Agreed. Dislike #1 makes me feel funny because you don’t really “go paperless” if you’re digitizing and printing out and redigitizing the same data. Dislike #2 is also less obvious, but important. Searchability is improved when records are rigidly structured, but it seems more natural to write a narrative, as you pointed out.

    Thanks for sharing!

    Effy @ Hospital Songs

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