Electronic Medical Records – A Look at the Past With a View Into the Future

Steven Spielberg

Computer-based systems utilized to record, deliver and manage patients’ personal medical data are known as Electronic Medical Records (EMR). Any information taken at doctor visits, including medical history, physicals, lab tests, prescriptions, referrals and procedures performed in the office, hospital or clinic can be transferred to computer-based patient records (CPR). This data can also include biopsies, imaging, specimen tests and diagnostic testing procedures.

Methods of medical documentation have evolved over the past 50 years, with the concept of electronic medical record (EMR) first introduced in 1969. Through the early 1960s, most doctors used handwritten notes in charts to record patient care. With the development of the mini cassette in 1967 and the micro cassette in 1969, physicians and hospitals began adopting dictation/transcription which permitted more legible and thorough documentation of medical histories and examination findings. With the advent of digital computer technology we entered the age of the EMR and EHR (electronic health record).

Another important step in medical records management was the development of the Health Evaluation through Logical Processing (HELP) system in the late 1960s. This integrated hospital information system provided decision support for health professionals and demonstrated that computer systems could not only replace paper records, but also improve the process of care by enhancing the use of records.

In 1991, the Institute of Medicine published The Computer-Based Patient Record: An Essential Technology for Health Care. This seminal document presented blueprints for the future of computer-based patient records (CPR). In the 1997 revised version, an expert committee explored the potential of CPRs to improve decisions about diagnosis and care, provided database for policy making, and attempted to answer these questions:

– Who uses patient records? – What technology is available and what further research is necessary to meet users’ needs? – What should government, medical organizations, and others do to make the transition to CPRs?

In 2003, the Quality of Health Care in America Committee of the Institute of Medicine (IOM) filed a report titled Patient Safety: Achieving a New Standard of Care. In it, the IOM encouraged hospitals and physicians to adopt EMRs as a major step toward preventing medical errors.

Also in 2003, the RAND Health Information Technology Project began a study of EMRs with two objectives:

1. To better understand the role and importance of EMRs in improving health care
2. To encourage government actions that could maximize the benefits of EMRs and increase their use

The RAND study estimated the potential savings, costs, and health and safety benefits of EMRs if adopted widely and used effectively. Some of the key findings of the study included:

– Health Information Technology would save money and significantly improve healthcare quality. – The annual savings from efficiency alone could exceed $77 billion. – Health and safety benefits could double the savings while reducing illness and prolonging life. – Obstacles to adoption of EMRs include market disincentives because in general, those who pay for Health Information Technology do not receive the related savings.

In response to these findings, the federal government moved to improve health care quality and efficiency, and established the goal that most American would have an EMR within ten years. But despite the involvement of numerous federal agencies, electronic systems have been adopted by only a small number of physicians and hospitals. The New England Journal of Medicine reported that, in a 2008 study of 2,758 primary care physicians, only 4% reported having an extensive, fully functional electronic records system, and 13% reported having a basic system.

According to a 2004 study by Miller and Sim, private practices have been slow to adopt EMR because of early start-up costs and uncertain financial gains. They noted that upfront costs for EMRs ranged from $16,000 to $36,000 per physician. In the initial weeks of using a new system, many practices also see fewer patients and spend more time entering data into their EMRs, which leads to longer work days.

Area hospitals or testing centers experience data exchange issue with EMRs and laboratory or radiology systems. The necessary computer programs for such exchanges are either unavailable, or costly to maintain and upgrade.

Despite these barriers there are numerous advantages to adoption of EMR in private practice. Predictions based on statistical models suggest that Health Information Technology has the potential to assist in dramatically transforming the delivery of health care, making it safer and more effective.

My personal experience with EMR has been altogether positive. In 1996, after fifteen years of private practice in podiatry, I transitioned from a dictation/transcription system to MD Logic, Inc., an electronic medical documentation system. Within the first year I realized a profit on my investment resulting from more accurate coding and increased efficiency in office work flow, as well as increased referrals related to improved communications with referring physicians. The most significant effect, however, was an increase in quality of care to my patients. As the podiatric knowledge base evolved, I was able to spend more time in face-to-face interaction with my patients, and less time documenting.

In 2006, I transitioned my group practice into MD Logic Worldwide EMR, a fully functional EMR. This enabled our office to go paperless. All components of the patient’s medical record are stored on a hard drive and accessible from any computer at all of our offices. The streamlining of work flow and elimination of redundant tasks resulted in major improvement in the efficiency and attitudes of employees. Instant access to patient’s medical records and insurance information has proven to be an invaluable resource. In addition, the creation of an interface permits transfer of information from the medical record to the practice management billing software.

At this time, the future direction of EMR appears to be in the hands of the government. The American Recovery and Reinvestment Act of 2009 provides significant cash incentives to physicians who implement electronic health records. However, in order to qualify for these incentives the physician must not only have the proper software but must engage in “meaningful use” of the software. The government plans to publish the criteria for meaningful use in February 2010. ARRA incentive reimbursement to physicians will begin in 2011.

Early adopters of EMR have been able to reap the numerous benefits of this innovative technology while preparing for 21st century health care delivery. Physicians now have a tool which can dramatically improve their medical outcomes and the quality of their patient’s lives.

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