Monday, October 17, 2005

What is EMR?

What is EMR?

EMR is an anacroym for (E)lectronic (M)edical (R)ecords. EMR can actually cover quite a range of items. EMR can be an electronic wrist band containing a person's vital medical data. It can also be the complete set of "notes" your doctor records during your visit entered into a database during your visit. Taking paper records and scanning them into a electronic version is a form of EMR.

Benefits of EMR?

Our office went to EMR just over 5 years ago. We read all the info on how much money it will save and how much more efficient it will make the practice. "Leaving more time for patient care and less time spent on record keeping." I still see web sites touting these claims. As computers became more popular in just about every office setting; one claim was there would be less paper. Have we seen that?

Well from the previous paragraph you may conjure I'm not too fond of EMR's. Actually quite the contrary, I am very happy with the improvements after introduction EMRs in our practice. We do run more efficiently, and more time is spent with patients and less on record keeping. (Even though most third party payors have increased the requirements of paperwork.) But all of this came at quite an expense in both time and money. The initial expense of software and hardware at the start far outweighed any efficiency we saw. We did not fire anyone. Typically this is one of the line items that will "save" money with the switch to EMR. You will save the cost of one or two employees. While that was not our experience at the start, in fact we possibly could have hired more help, but we would not have fired anyone regardless. Contrary to the urban legend that computers are replacing jobs. What we did gain is a complete and reliable record of our patient visits. No more misplaced charts. Someone in the front of the office need to see the record? And then someone in the back (we have a large office), no problem. Or better yet someone in office A needs to discuss it with someone in office B (we have multiple locations). These are all possible with ease. Sunday morning Mrs. Jones runs out of her prescription? She doesn't know what it is. Again no problem with EMR. I won't even begin on the improvements in legibility of the records.

Problems moving to EMR?

One of most difficult to measure parts of the equation to establishing an EMR system is training. One of the problems is programmers don't think like doctors and doctors don't think like programmers. So what may be intuitive for one isn't to the other. Additionally neither likes change. Physicians make decisions all day long, some of them could be life or death, so there is a confidence in their process which is nurtured. Programmers create, and no-one likes when you criticize your "child". The result are systems that don't always mesh. A system that looks like it will "fit like a glove" doesn't always comply.

Standardization. Standardized EMR is an oxymoron. It's job security for the vendor not to have standardized formats. If anyone has every converted computer systems you know what I mean. This may be quite some feat as Ophthalmologists won't use an EMR system in the same way an Internist will use it. But some sort of standard record in an open source format (SQL?), needs to established. And then the eye doctor can interface with his portion of the record and the family doctor can do the same.

What's the Future?

Only about 20% of the medical field has EMR as of 2003. This will change but how quickly? Doctors recognize the need. Patient will require it. Who will foot the bill? Who will provide the "standardization"? Over the next 5 years 20% will double to over 50% is my predication, and close to 100% in 10 years. Just don't ask me how.

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