Continuity of Information: Will EMRs Remedy Discontinuity of Care?

With digital records, hospitals and doctors shift toward “continuity of information” from continuity of care

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Back when health information technology amounted to a clipboard, paper and a pen, “continuity of care” was one of the bedrock principles of medicine. It meant that whenever possible, primary-care physicians should oversee their patients’ care, serving as healers and advisors through every phase of the medical experience. Those days are all but gone, replaced by 15-minute office visits and episodic medical encounters, as patient migrate from one doctor to the next, depending on who’s covered in their insurance plan.

One proposed remedy for such a deeply fragmented health system is a national system of electronic medical records. The Obama administration is pushing the new technology by providing up to $27 billion in incentives over 10 years to doctors and hospitals that adopt it. Michael Painter of the Robert Wood Johnson Foundation, a major public health philanthropy that is backing the initiative, says electronic medical records are designed to improve the quality and efficiency of medical care by “attach[ing] information to you that follows you wherever you go.”

What isn’t clear is whether “continuity of information” will make up for the loss of “continuity of care.” Or whether it will live up to its billing, assuring that no matter what doctor you see--or which hospital you land in--you’ll get quality treatment tailored to meet your needs. Anthony DeMaria, professor of medicine at the University of California, San Diego, says electronic medical records can help assure quality and safety in many important ways, from providing limitless data for medical research to connecting the dots in perplexing patient encounters. “I’ve struggled at times when I’ve had to see a patient admitted to the hospital or clinic and have no medical record—I can’t tell what’s going on,” DeMaria says.” The electronic records are also invaluable, he says, for providing critical reminders about drugs or procedures that might be overlooked.

The technology can empower patients, too, by giving them access to their own health histories--information patients are eager to have. The Department of Veterans Affairs, an early adopter of electronic medical records, installed a portal on its website called the Blue Button, where veterans can retrieve their medical records. Since the Blue Button was established two years ago, as many as half a million veterans have used it to download their VA clinical records and claims information.

But transitioning from paper to the computer is costly and logistically challenging. Many of the systems now in place may digitize medical records but they don’t provide information to patients or link up with other data networks. A Robert Wood Johnson Foundation analysis released last week found that 18 percent of hospitals reported meeting the minimal federal standard for electronic health records last year, up from 4.4 percent in 2010. Only 10 percent of doctors have adopted electronic health records systems that meet the minimum standards defined by the government.

Although Farzad Mostashari, U.S. National Coordinator of Health Information Technology, says there’s been more progress in getting hospitals and doctors to adopt electronic health records “than in decades before,” there’s still a long way to go.

In more ways than one. Even as more doctors and hospitals adopt electronic medical records, concerns have arisen about possible downsides to the technology. Already, some patients fret that their doctors spend more time typing than engaging and listening carefully to their concerns. Doctors complain too that sitting at a keyboard diverts their attention from patients. DeMaria says much may be gained, but much may also be lost if doctors mistake data for a deeper knowledge of patients, including their hopes, their fears and their family circumstances. “When I’m sick, the rapport I have with a physician who’s taking care of me makes a big difference to me,” he says. “Does he know me?” Or am I just a bunch of pixels blinking on a screen?