Internet-enabled electronic medical records (EMRs) continue to be a major healthcare initiative in the United States, but as late as mid-2009, the US still significantly trailed other industrialized countries in physician adoption of EMR.
The same Commonwealth Fund survey revealed that 78 percent of US physicians who used seven to 14 computerized functions --such as decision support or drug and allergy alerts -- felt well prepared to take care of patients with multiple chronic diseases, compared to 68 percent of physicians with low IT capacity.
The difference is significant: Each year, over 100,000 people die in the US because of medical errors. Yet many physicians are still hesitant to use EMR.
“I have been practicing medicine nearly thirty years,” said one New York City physician. “Using EMR is time-consuming, and it gets in the way of my relationships with my patients.” A Midwest general practitioner echoed the sentiment: “I am in a situation where the clinic where I work has mandated using EMR, and it takes me six to eight hours a week to learn how to use it and to input information. Instead, I could be using this time to see more patients.”
A recent Centers for Disease Control study found 7.6 percent of physicians older than 65 used some form of EMR, compared with 47 percent of physicians younger than 35 -- but the slow movement to EMR has more story lines to it than age.
Let’s take a closer look at the factors involved in physicians’ EMR adoption (or lack thereof):
Cost. The average cost of an EMR system is $20,000. Many smaller medical practices have found EMR hard to afford and to implement, even though the federal government now affords doctors $44,000 over five years for EMR hardware and software.
Changes in the doctor-patient relationship. There are physicians who believe that electronic tools like EMR dehumanize the doctor-patient relationship. “Have you ever been ignored by someone who was texting or otherwise engaged in a digital conversation? Did you feel that the person was being rude and unresponsive to you? If your answer to both of these questions is ‘Yes,’ then you will understand the real reason why some doctors don’t want to adopt electronic medical records systems (EMRs),” recently blogged an anonymous doctor. “We know instinctively that the human side of medicine -- the attentive listening, the visual cues, the continued eye contact, and the careful history and physical exam -- is critical to our profession. The problem we have with EMRs is that they often interrupt the sensitive and intuitive parts of what we do. EMRs and other digital ‘tools’ designed to make our work more efficient, may do so at the expense of the human connectedness our patients deserve and need.”
Integration. The majority of medical records are paper-based, and there currently is not a standardized EMR, nor a universal interface that assures that all EMR systems can talk with one another. This lack of interoperability does little to eliminate the risks that doctors and other medical practitioners already face when it comes to ensuring that every medical and pharmaceutical detail about a given patient is known.
Despite these challenges, EMR adoption is continuing to move steadily forward in both technology and medical quarters. The Internet plays a major role in facilitating interoperability in medical records management, and technology companies and healthcare are pooling their efforts.
One example is the Mayo Clinic-IBM project known as the Open Health Natural Language Processing Consortium, which focuses on tools used for searching medical records and data.
Also encouraging is February 2010 data indicating that the number of US physicians using EMR has risen to 36 percent. “I’m getting used to EMR,” reported the Midwest GP. “And I’m starting to see the benefits in easier access to patient information.”
— Mary E. Shacklett, President, Transworld Data