Electronic Medical Records: The Tip of the Health IT Iceberg

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By Jessica D. Herr, PharmD’00

It is probably safe to assume that most of us have heard of electronic medical records (EMRs), but few of us have seen EMRs in use. Although EMRs have been around to some extent since the 1970s, the current healthcare system remains unable to accommodate the full potential of EMRs or health information technology (IT) in general.

No one needs to tell this to Richard Stefanacci, DO, MGH, MBA, AGSF, CMD, or James C. Pierce, PhD, two faculty members who have been interested in the field of health IT for well over a decade. One might ask, if EMRs have been around, even in their infancy, for so long, why aren’t they in my healthcare provider’s office yet?

The answer to this and many other questions surrounding EMRs and health IT were addressed during the symposium titled, “The Future of Health Information Technology: Defining a Vision for Digital Healthcare.” The sixth in a series of symposia on major challenges facing the U.S. healthcare system, and sponsored by the University’s Mayes College of Healthcare Business and Policy, the symposium included a panel of three pioneers of health IT and was lead by Carolyn M. Clancy, MD, director of the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

The symposium could not have been held at a better time, as health IT is at the cornerstone of healthcare reform. In fact, in February 2009, President Obama allocated $20 billion to EMR and health IT in the American Recovery and Reinvestment Act, with the goal of having an EMR for every person in the U.S. by 2014. Currently, EMRs are estimated to be in place in less than 20 percent of practices in the U.S., which makes the goal of 100 percent adoption within the next five years a daunting task.

Paving a Future Path
For universal adoption and successful implementation to occur, one must first identify the challenges that lie ahead and develop strategies for overcoming potential barriers to implementation. In theory, EMRs will improve efficiency and quality of care, reduce medical errors, and save lives. In the long run, EMRs are expected to be more cost-effective than current paper records. But try telling this to the thousands of small clinical practices throughout the U.S. that will be forced to dole out tens of thousands of dollars to acquire the technology necessary to implement EMRs, only to have the technology become obsolete soon thereafter, and you will surely be faced with skepticism.

Fortunately, much of the $20 billion stimulus bill will assist healthcare providers in upgrading their technology. In addition to the cost to purchase and implement the technology and software, EMRs are also likely to reduce provider productivity initially, in turn reducing their reimbursement and income potential. The indirect cost of EMRs should decrease with time as providers become more proficient in their use.

Challenges to Adoption

When asked to identify the greatest potential challenges to successful implementation of EMRs, other than cost, Drs. Stefanacci and Pierce both agreed that EMRs present a number of potential challenges, including:

• storage—a tremendous amount of memory will be needed to store all of the information included in the EMR.
• ownership of the record—who will be responsible for keeping the record (patient, provider, managed care company, other).
• software compatibility—there are currently several software vendors providing customizable software and no standardization guidelines exist.
• protection of patient privacy—the potential for widespread dissemination of confidential information, whether intentional or accidental, is far greater than with paper records.
• training—there is no mechanism in place to train physicians and other healthcare providers on the use of health IT or how the use of EMRs alters patient-provider communication, and medical schools are not equipped to handle this task.

Not surprisingly, these same challenges were identified during the health policy symposium by Dr. Clancy and the symposium panelists.

If we can successfully achieve adoption of EMRs within the next five years, then we are sure to see advances in other areas of health IT. Dr. Stefanacci, through his work in the Institute for Geriatric Studies, has witnessed firsthand how the use of electronic prescribing, community-based automatic medication dispensers, and electronic health sensors can benefit seniors, allowing them to move from a nursing home to independent community living. According to Dr. Stefanacci, “Health IT is much more than EMRs. The use of technology can improve medication management and home monitoring, making it possible for seniors to remain safe at home rather than being forced to move to a nursing home. This is better for seniors and saves society financially as well. But this is only possible if we have an educated workforce up to this challenge.”

Medical Informatics Track
Health IT presents a unique opportunity to unite two diverse specialties, healthcare and IT. The University is in an ideal position to equip healthcare providers with the tools necessary to make health IT a reality. In 2008, the University announced the approval of the medical informatics track in the computer science program, and the first students to enter this track are expected to start in the 2010–2011 school year.

“The medical informatics program will give students the technical skills to succeed in the 21st-century world of computers and information technology that is rapidly integrating into all aspects of healthcare,” according to Dr. Pierce, chair of the Department of Bioinformatics and Computer Science. “Students will graduate with a bachelor of science in computer science degree and will have a strong academic background in the health sciences. This combination of skills and knowledge will be critical for an individual’s successful career and leadership position in the modern medical information technology workforce.”

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Comments

[software developer]

That was an inspiring post,
This is some very interesting information about electronic medical records,
Thanks for bringing this up

[cardiology emr]

Implementing EMR I think will definitely lead to better care..It could improve the quality and accuracy of medical-record documentation and improve quality of care.

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Why is gold used in electronic products as a conductor instead of
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EMR IS the tip of the iceberg...to better medical care.

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Nice tips! Some study says, EMR will also protect us if we use the system well and are meticulous about our usage. The EMR record can document that patients were notified of test results and were given instructions on when to follow up with us. Anyway, thanks for sharing this post. I've got some idea.

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Electronic medical records are going to be the fresh, cool breeze of the medical world!
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Share | By Jessica D. Herr, PharmD’00 It is probably safe to assume that most of us have heard of electronic medical records (EMRs), but few of us have seen EMRs in use. Although EMRs have been around to some extent since the 1970s, the current healthcare system remains unable to accommodate the full potential of EMRs or health information technology (IT) in general. No one needs to tell this to Richard Stefanacci, DO, MGH, MBA, AGSF, CMD, or James C. Pierce, PhD, two faculty members who have been interested in the field of health IT for well over a...