Over the past year, there has been increasing pressure
placed on physicians by the federal government to adopt electronic health and electronic medical record keeping (EHR/EMR) into their practices.
While this "encouragement" may have good intentions, it is not being embraced by the medical community.
This may be for good reason, and part of that may be the lack of skills among many in the medical profession to properly keep records the "good old-fashioned way" -- and those old-fashioned skills are a prerequisite to EHR/EMR.
Last week, a blog in the Houston Chronicle cited some staggering figures about the Texas Medical Board's announced disciplinary actions against 70 doctors, 12 of whom were in the Houston area alone.
Of those 12, nine lost their licenses, were financially penalized, or are required to attend training because of their lack of proper medical record keeping. Four actions were specifically related to failed record-keeping practices.
And this isn't the first time this has happened in Texas by a long shot -- in November 2009, 75 actions were taken against physicians, and 28 of those were related to improper record keeping.
Hopefully, Texas will set a precedent and other states will start taking a harder look at this issue, especially with the pending incentives to increase the use of EMR/EHR.
I think this points out what I (and many others) have said previously, however: Simply moving from physical-format records to electronic records is not going to improve the quality of diagnostics and healthcare.
It may in fact have just the opposite effect if a physician lacks the skill to capture information in an effective manner. Of note in the recent Houston Chronicle article was the fact that many of those who were cited are being required to attend CME (Continuing Medical Education) training for medical writing.
This begs a question: What training is being developed to ensure that those being asked to create medical records in electronic formats know how to adequately prepare and manage these records?
Further, effective EMR/EHR isn't just about creating good records. There's also the aspect of records management, including:
- How files are saved
- How metadata is entered
- How systems are backed up
- How content is protected against accidental or improper access
- How systems are restored following a power outage
- How systems are protected against a disaster or other emergency
- How content is taken offline and/or transferred to others
And the list goes on. Naturally, physicians themselves may not be performing many of these systems management functions, but based on the recent citations by the Texas Medical Board, it appears they are held responsible for the proper record keeping of their offices.
Managing records in electronic formats will place increased burdens on both physicians and front-office staff. These burdens will include learning how to place controls on access and privacy and ensuring the ability of persistent access to a growing volume of data, much of which will be in proprietary formats.
Extensive training will be required for backing up data daily and storing backups in places other than the primary place of business. It also will involve periodic conversion and migration as formats change, since many systems used to generate medical information are proprietary rather than open source.
And this doesn't even consider electronic data interchange with othersâ€¦ But that's a topic for another post.
— Larry Medina has spent 37 years in the Records and Information Management (RIM) profession.