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EMRs

Getting information off the Internet is like taking a drink from a fire hydrant - Mitchell Kapor

 

Even after 40 years when EMRs were first discussed, there is surprisingly a strong resistance against the use of EMRs and quite frankly it's taking quite a while to catch on in the medical community. Medical information, in most cases, continues to be recorded on paper written in a patient's record at every doctor's office the patient has visited or in the medical chart hanging at the foot of a patient's hospital bed.

So, let us take a look at what EMRs are supposed to do. As expected, the proponents are primarily the vendors themselves, government agencies and most health care providers.

EMRs minimize errors - The use of EMRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable.

EMRs keep records safe - Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications. Online services such as the Cleveland Clinic’s MyChart and HealthVault can help patients in record keeping.

EMRs make health care cost-efficient -  EMRs consolidate all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. Think of the amount of time and money spent on phone calls, emails, and faxes to get access to records from other places. In some cases, medical tests that have already been done are repeated all over again, incurring unnecessary costs to the patients and the health care system. In 2009, the first city-wide electronic health information exchange in the U.S. was implemented in Indianapolis. The Indiana Network for Patient Care was developed from the Regenstrief Medical Record System which is a database of 9.6 million patients. The system is expected to improve health and lower costs.

EMRs facilitate coordination between health professionals -  The coordination between primary care providers and the hospital care of patients has always been problematic. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange.They reported that discharge reports from hospitals frequently do not get to the general practitioners in time, resulting in decreased quality of care after hospitalization. Furthermore, the reports tended to be inaccurate and incomplete, often lacking relevant data about tests and new medications. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization.

EMRs translate into better treatment for patients -  Efficiency and speed of diagnosis translates into better health care service for patients. Similar to the previously discussed point, correct and timely information can significantly increase the quality of health care service rendered to patients. Take the example of one asthma center’s experience with EMR: A major benefit associated with EMR implementation was the increase in the number of children who were hospitalized with an asthma exacerbation and received an asthma action plan upon discharge. Prior to the EMR system, [only] 4% received an asthma action plan upon discharge. After implementation of the EMR system, 58% received an asthma action plan upon discharge”.

EMRs can save lives - In many cases, EMRs may save peoples’ lives. Researchers at the Regenstrief Institute in Indiana have been working on EMRs for years which can be used in disease surveillance during epidemics and bioterrorism. And although controversial, implantable chips that store your medical records are on the way. The U.S. FDA recently gave approval to VeriChip corporation, now Positive ID to market an implantable RFID microchip for use in both humans and pets.

EMRs give patients control over their health records - Based on the principle that since it’s the patient’s medical record, the patient should control it, decide what should be in it, and who gets access to it there are currently many online EMRs available including Microsoft's HealthVault. Several prestigious medical institutions including the Cleveland clinic have synced up with HealthVault.

OK, what are the disadvantages of EMRs? Not surprisingly, privacy rights advocacy groups are the main opponents of EMRs. Here is what they have to say:

EMRs threaten our privacy - In this day and age when people’s mantra is “I need my privacy”, not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see – in other words, incursion into people’s privacy. The confidentiality of doctor - patient relationship is still sacrosanct. In addition, there is criticism over whether online EMRs satisfy the requirements of the Health Insurance Portability and Accountability Act of 1996 for the privacy of patients' health records.

Besides, medical data can be used against a person in some cases – be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people’s fear of incursion into their private sphere.

EMRs can lead to loss of human touch in health care - In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words.

However with EMRs it's simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

EMRs are not that efficient - Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic’s EMR system is not compatible with that of a general practitioner or another clinic’s system, thus belying the claim of added efficiency.

EMRs are not safe and secure - Very few people are confident about the data protection and security of electronic data such as those stored in EMRs. Many people are not convinced that their data are safe from those who would want to misuse it. "Though  some may worry about the security of patient portals, experts say  accessing your health information online is no more risky than using  online banking. In 2009, the Department of Health and Human Services  started requiring providers to report all potential privacy breaches of  personal health information, whether accidental or deliberate. " Source: Electronic Health Records Gaining Acceptance, U.S. News & World Report, September 4, 2012.

Implantable EMRs are not for humans It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the government or industry says. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. .

So, where do we go from here? The main issues that need to be overcome are data security, protection of privacy and gaining the confidence of patients. It doesn’t seem evident that the use of RFID and similar tagging chips will become acceptable or popular anytime soon.

However, we live in a digital world and we cannot hold back progress indefinitely. So, to help make your professional life just a little easier here's some of Health WorldNet's favorite EMRs and health management resources. 


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