| Computer-based systems utilized to record, | | | | most American would have an EMR within ten |
| deliver and manage patients' personal medical data | | | | years. But despite the involvement of numerous |
| are known as Electronic Medical Records (EMR). | | | | federal agencies, electronic systems have been |
| Any information taken at doctor visits, including | | | | adopted by only a small number of physicians and |
| medical history, physicals, lab tests, prescriptions, | | | | hospitals. The New England Journal of Medicine |
| referrals and procedures performed in the office, | | | | reported that, in a 2008 study of 2,758 primary |
| hospital or clinic can be transferred to | | | | care physicians, only 4% reported having an |
| computer-based patient records (CPR). This data | | | | extensive, fully functional electronic records |
| can also include biopsies, imaging, specimen tests | | | | system, and 13% reported having a basic system. |
| and diagnostic testing procedures. | | | | According to a 2004 study by Miller and Sim, |
| Methods of medical documentation have evolved | | | | private practices have been slow to adopt EMR |
| over the past 50 years, with the concept of | | | | because of early start-up costs and uncertain |
| electronic medical record (EMR) first introduced in | | | | financial gains. They noted that upfront costs for |
| 1969. Through the early 1960s, most doctors | | | | EMRs ranged from $16,000 to $36,000 per |
| used handwritten notes in charts to record patient | | | | physician. In the initial weeks of using a new |
| care. With the development of the mini cassette | | | | system, many practices also see fewer patients |
| in 1967 and the micro cassette in 1969, physicians | | | | and spend more time entering data into their |
| and hospitals began adopting dictation/transcription | | | | EMRs, which leads to longer work days. |
| which permitted more legible and thorough | | | | Area hospitals or testing centers experience data |
| documentation of medical histories and | | | | exchange issue with EMRs and laboratory or |
| examination findings. With the advent of digital | | | | radiology systems. The necessary computer |
| computer technology we entered the age of the | | | | programs for such exchanges are either |
| EMR and EHR (electronic health record). | | | | unavailable, or costly to maintain and upgrade. |
| Another important step in medical records | | | | Despite these barriers there are numerous |
| management was the development of the Health | | | | advantages to adoption of EMR in private practice. |
| Evaluation through Logical Processing (HELP) | | | | Predictions based on statistical models suggest |
| system in the late 1960s. This integrated hospital | | | | that Health Information Technology has the |
| information system provided decision support for | | | | potential to assist in dramatically transforming the |
| health professionals and demonstrated that | | | | delivery of health care, making it safer and more |
| computer systems could not only replace paper | | | | effective. |
| records, but also improve the process of care by | | | | My personal experience with EMR has been |
| enhancing the use of records. | | | | altogether positive. In 1996, after fifteen years of |
| In 1991, the Institute of Medicine published The | | | | private practice in podiatry, I transitioned from a |
| Computer-Based Patient Record: An Essential | | | | dictation/transcription system to MD Logic, Inc., an |
| Technology for Health Care. This seminal | | | | electronic medical documentation system. Within |
| document presented blueprints for the future of | | | | the first year I realized a profit on my investment |
| computer-based patient records (CPR). In the | | | | resulting from more accurate coding and |
| 1997 revised version, an expert committee | | | | increased efficiency in office work flow, as well as |
| explored the potential of CPRs to improve | | | | increased referrals related to improved |
| decisions about diagnosis and care, provided | | | | communications with referring physicians. The |
| database for policy making, and attempted to | | | | most significant effect, however, was an increase |
| answer these questions: | | | | in quality of care to my patients. As the podiatric |
| - Who uses patient records? - What technology is | | | | knowledge base evolved, I was able to spend |
| available and what further research is necessary | | | | more time in face-to-face interaction with my |
| to meet users' needs? - What should | | | | patients, and less time documenting. |
| government, medical organizations, and others do | | | | In 2006, I transitioned my group practice into MD |
| to make the transition to CPRs? | | | | Logic Worldwide EMR, a fully functional EMR. This |
| In 2003, the Quality of Health Care in America | | | | enabled our office to go paperless. All components |
| Committee of the Institute of Medicine (IOM) filed | | | | of the patient's medical record are stored on a |
| a report titled Patient Safety: Achieving a New | | | | hard drive and accessible from any computer at |
| Standard of Care. In it, the IOM encouraged | | | | all of our offices. The streamlining of work flow |
| hospitals and physicians to adopt EMRs as a major | | | | and elimination of redundant tasks resulted in |
| step toward preventing medical errors. | | | | major improvement in the efficiency and attitudes |
| Also in 2003, the RAND Health Information | | | | of employees. Instant access to patient's medical |
| Technology Project began a study of EMRs with | | | | records and insurance information has proven to |
| two objectives: | | | | be an invaluable resource. In addition, the creation |
| 1. To better understand the role and importance | | | | of an interface permits transfer of information |
| of EMRs in improving health care | | | | from the medical record to the practice |
| 2. To encourage government actions that could | | | | management billing software. |
| maximize the benefits of EMRs and increase their | | | | At this time, the future direction of EMR appears |
| use | | | | to be in the hands of the government. The |
| The RAND study estimated the potential savings, | | | | American Recovery and Reinvestment Act of |
| costs, and health and safety benefits of EMRs if | | | | 2009 provides significant cash incentives to |
| adopted widely and used effectively. Some of the | | | | physicians who implement electronic health |
| key findings of the study included: | | | | records. However, in order to qualify for these |
| - Health Information Technology would save | | | | incentives the physician must not only have the |
| money and significantly improve healthcare quality. | | | | proper software but must engage in "meaningful |
| - The annual savings from efficiency alone could | | | | use" of the software. The government plans to |
| exceed $77 billion. - Health and safety benefits | | | | publish the criteria for meaningful use in February |
| could double the savings while reducing illness and | | | | 2010. ARRA incentive reimbursement to |
| prolonging life. - Obstacles to adoption of EMRs | | | | physicians will begin in 2011. |
| include market disincentives because in general, | | | | Early adopters of EMR have been able to reap |
| those who pay for Health Information Technology | | | | the numerous benefits of this innovative |
| do not receive the related savings. | | | | technology while preparing for 21st century health |
| In response to these findings, the federal | | | | care delivery. Physicians now have a tool which |
| government moved to improve health care | | | | can dramatically improve their medical outcomes |
| quality and efficiency, and established the goal that | | | | and the quality of their patient's lives. |