Me: "What medications do you take at home?"
Patient: "Ohh, I take this little green one at night and the big white one in the morning and one at night".
"Do you remember the names of these medications or the amounts?"
"Oh no my daughter gives them to me."
"Who is your doctor?"
"He is at the [local] clinic."
"What is his name?"
"I don't remember."
"Have you ever had a heart attack?"
"Last year my doctor was worried about my heart so he did this big test where he put this thing on my chest and then he said I did have a heart attack but that my heart was OK."
"Did you see a special heart doctor?"
"I don't know but I did see this other doctor who told me that I have cancer in my chest."
"What? What kind of cancer? Did you get treated?"
"Oh no because my other doctor told me that I didn't have cancer so I never went back to him."
. . . etc. etc. etc.
Of course the usual tests will still get done to evaluate this patient's symptoms but this patient's care would certainly be safer (i.e. avoiding duplicate invasive testing), better, and more efficient if I had easy and quick access to her constantly updated medical records. However, currently record keeping in the medical industry is a complete and total mess. In my experience most paper records are either inaccessible within a reasonable amount of time (sequestered in doctor's offices over the weekend or holidays or deep in a hospital's basement) incomplete, confusing, or very poorly done.
Many private physician's offices are converting over to electronic medical records (EMRs) and most hospitals already have some type of computerized recording keeping but very few of these different systems are compatible meaning that there is no way to transfer information between them. Because of such fragmentation most of these EMR systems remain useful only to physicians within that system (hospital or office practice). If patients travel between different systems to get care we are usually left with the same difficult Q&A session like the hypothetical one above.
National Health Information Technology Coordinator Dr. David J. Brailer is the point man in the Federal government's efforts to change the system. His message to the health care and information industries is simple; Agree on a system of standards and uniformity that would allow different EMRs to talk to each other or government will make the decision for you. The approach, he said, must include a method to certify that the records can be opened and read by doctors and specialists, as authorized by the patient, even when different clinics and hospitals have different computer systems. If the industry cannot agree upon such standards by this summer, "then government will probably do what government does best - put out a mandate."
What is motivating government to push for uniform EMRs? It's possible that eRecords could save 10% or more in yearly health care spending by eliminating the need for so much duplicate testing (often needed when paper records are not available). The other assumption is that eRecords will lead to better medical care and help to eliminate medical errors (this alone is worth the price of admission).
Many barriers still remain, however. The obvious one is cost. The health care industry usually pours its investment capital into new and expensive diagnostic and treatment systems leaving very little for improved record keeping and patient tracking. Who is to pay for all these new and very expensive EMRs? You and I, that's who. Either through higher insurance premiums or taxes. With any luck the money saved by improved record keeping will more than pay for these initial costs but this is still another example of how we are going to have to pay for better medical care.
Security and privacy is another concern especially considering the HHA's HIPAA regulations. Even though HIPAA does not prohibit the electronic transmission of medical records it does set standards for the protection of files and data on a system from unauthorized access. In most cases these standards are reasonable and straightforward and not unlike what my bank does to protect my online account information. However, security concerns do hamper access (the computer system at the hospital where I practice is not currently accessible from the internet because of concerns about hacking).
I would hate to see these security concerns seriously constrict the growth of EMR systems and efforts to connect these systems using the internet and wireless communication. The pros to patient care far outweigh the cons of security and privacy concerns. While such serious crimes as identity theft, credit card fraud, and theft of funds are potential huge problems for the online banking industry consumers appear more concerned about the privacy of their electronic medical records than they do about their own financial information and credit reports which are usually potentially accessible online.
What they should be concerned about is the pathetic condition of their medical records if kept in paper form. As Harvard professor and EMR advocate Dr. Bleich stated in 1993; "The (paper) medical record is an abomination ... it is a disgrace to the profession that created it. More often than not the chart is thick, tattered, disorganized and illegible; progress notes, consultant's notes, radiology reports and nurses notes are all co-mingled in accession sequence. The charts confuse rather than enlighten; they provide a forbidding challenge to anyone who tries to understand what is happening to the patient."
