The Era of Electronic Medical Records

Medicine is entering a new era of information technology.

By + More

Electronic records should also enable specialists who see a patient to work more as a team. Over time, most patients see several specialists in addition to their primary care physician. Until now, each doctor has kept his own chart for each patient, leading to duplicate tests and time wasted by answering the same questions from different doctors. By giving all of a patient's doctors access to one unified patient file, an EMR system wipes out longstanding bottlenecks in healthcare. There are no paper records that a patient's primary care doctor might forget to send to the specialist she sees next, nor does the patient herself have to pick up her X-rays beforehand. The specialist calls everything up on his screen. "The patient doesn't have to try to remember information, and the doctor doesn't need to make the best decision he can based on what's available," says family physician Steven Waldren, director of the American Academy of Family Physicians' Center for Health IT. "He can look at the patient's record from the last 15 years."

To make this happen, physicians with office-based practices will have to buy a combination of hardware and software estimated to cost about $20,000 per physician initially. In a study published in March in Health Affairs, researchers put the first-year expense of installing an EMR package and training staff at more than $230,000 for a five-physician office. The good news: If the office meets the not-very-rigorous "meaningful use" standards—indicating that they use the system to perform a certain number of required tasks, like issuing a certain percentage of prescriptions electronically, rather than on paper—most of the cost will be covered by the government.

The bad news: Each doctor, according to the Health Affairs study, will need about 134 hours to learn how to properly use the system. That's a lot of time away from patients, which especially galls doctors who feel that the new technology is being forced on them. "Think of it like the change from phonebooks to looking up information online," says White. "It's new and it's easier, but it's also a different way. Not everyone is comfortable with that change." Moreover, there are hundreds of EMR systems certified by private organizations. They vary by screen display, content, organization, and features, like allowing patients to do virtual doctor visits. It's hard to imagine physicians and their staffs competing with one another to see who gets to sort through the offerings.

It is still too soon to trust sweeping statements about EMR's demonstrated value (or lack of it). Research findings are mixed. But fixing blame for a failed effort is slippery. The fault could lie with the particular EMR system, how it was implemented, resistance from clinicians, or a long list of other factors. The same system at a different clinic or hospital might produce every result promised.

A study published last year in the American Journal of Managed Care found that EMRs can lead to a higher quality of care—if they include interactive features, like software that skims records looking for gaps in care, such as an overdue mammogram, and E-mails reminders to patients. Among Kaiser Permanente patients such a system was tested on, the tool bumped up the number of diabetes and heart disease patients who came for regular health screenings, vaccinations, and medication adjustments; after three years, the percentage of patients receiving recommended care each month jumped from 68 percent to 73 percent.

Call those encouraging but modest results a glass half-full. A study published in the Archives of Internal Medicine in January found a glass mostly empty. Researchers analyzed data from 255,000 outpatient visits to hospitals and doctors' offices, some of which had EMRs and others that didn't, between 2005 and 2007. The intent was to see whether EMR made doctors more likely to offer patients sound guidance and conduct recommended tests in 20 different areas, from discussing a daily aspirin with patients who have heart disease to routine measurements of blood pressure. In only one of the 20 (counseling adults about diet) did the investigators find evidence that using EMRs made a positive difference. Physicians using paper records, in fact, were far more likely to offer good medical advice about treating depression.