In 2011, doctors and hospitals will be able to tap $1.5 billion in financial incentives from the federal government to share records electronically. The purpose of this ARRA funding is to speed the computerization of medical records, permitting doctors near instant access to all the medical records, test results and drug prescriptions for their patients.
The goal is improve patient care by reducing errors and ensuring that doctors are able to quickly obtain accurate patient records. The data, at this time, is mixed, tending to show improved patient care, but also increased demands on doctors and their staff in setting up and administering electronic medical records (EMR).
The Department of Veterans Affairs has implemented a system for all of the VA hospitals to control the dispensing of drugs and the system has reduced prescription errors to nearly zero. Other studies have shown a reduction in infant deaths. Moreover, few would argue that the idea, as a concept, is bad. The devil is in the details, and with EMR, there are almost an infinite number of details.
Some doctors are uncomfortable with computers and are concerned with the amount of time required to input data. Patients worry they may have the doctor in the exam room typing into a laptop as they are examined. Doctors who have been in practice for years do not see the practical benefit to the system, as the initial high costs would not pay for themselves before they retire from their practice.
For younger physicians, there is a higher likelihood of their practice seeing an eventual payoff, in the form of more efficient administration of the office and greater accuracy in the treatment of their patients. Nevertheless, as with any computer system, overall effectiveness will be dependent on the willingness of the doctor and the administrative staff to be properly trained and fully implement the system. Offices that only partly implement a system, as a partial replacement for paper files, may see little improvement in total system efficiency and better patient care.
Technology
While the human component of the implementation any EMR system is not to be underestimated, a larger and potentially more problematic concern is the interoperability of the systems. Ideally, a clinic, a hospital and the insurance company should have compatible systems. This permits a patient admitted to a hospital to have their medical records reviewed by doctors quickly and efficiently, allowing them to chose a course of treatment that best matches what the patient needs. It also allows the insurance company to accurately reimburse a doctor, based on the correct information of the patient’s treatment.
As with the experience of the Department of Veterans Affairs, the large-scale deployment of a coherent system allows for an improvement of patient care, by ensuring the proper medicine is going to the patient. When done well, an EMR permits a seamless view for the doctor of the patient’s medical history, any prescriptions, tests, prior treatments, surgeries and illnesses. This would allow a doctor to see the big picture of the patient’s medical history.
Big Picture or Big Brother?
The corollary for making it easier for the doctor to review the complete medical history of a patient, of course, makes it easier for anyone to view the records. Privacy concerns figure very prominently from the perspective of many critics of these systems. Concerns abound about how access to EMRs is controlled and who could view the records.
A large concern for patients would be the disclosure to insurance companies of information that could be used to deny benefits or coverage as a preexisting condition. In addition, with numerous locations storing information (doctor’s office, clinic, hospital and insurance company), there are many potential places for unauthorized persons to obtain confidential records.
While others note that with paper records it was often impossible to know if anyone had viewed confidential information, there was a much smaller pool of persons with possible access. Admittedly, anyone in the doctor’s office could view a file if they had access to the file location, but in most situations, that would be a limited number of people. A hospital would have a greater number of persons with potential access; it is also more likely that files would be segregated into an area with limited or controlled access.
The danger that exists for EHRs if deployed on a large scale would be the much greater scale of potential access. If a doctor or emergency room nurse in Los Angeles can access the records of a patient from New York (a good thing if you have a medical emergency away from your home physician), those same records could be accessed by an insurance company looking to deny coverage.
Another concern is the potential for problems caused by errors in the records being spread throughout the system and becoming self-propagating. Again, the breath of the system creates a danger by making it difficult to correct errors that become stored in numerous locations. The solution for these types of issues would be a high degree of control, with redundant checks to ensure the accuracy and integrity of the data; of course, that adds to the administrative upkeep of any system.
Many people are offended by the prospect of anyone viewing what they may feel of as their most personal records. Information on their fertility, drug use, and many other intimate matters would be described in their medical records. The irony with EMRs is, to provide the greatest value to patients, the system needs to be comprehensively implemented across a wide spectrum of facilities and that large-scale implementation would mean they would need strict control and tight regulation to prevent uncontrolled access.
There are no easy answers to any of the issues raised by the increased use of EMRs, but patients should remain vigilant and ask their doctor how their medical records are maintained.
Article provided by Ronald J. Bua & Associates
Visit us at www.ronaldbua.com
