Why I Want A National EMR


Computer Keyboard, via Flickr's Prasan Naik

Computer Keyboard, via Flickr's Prasan Naik

One day My Prince Will Come, and his name will be Username Password. I dream for the day we have a nationalized medical record.

And we as emergency physicians should be its biggest advocates. What other doctors (besides, perhaps, outpatient doctors seeing a new patient for the first time) make do with as little information as we do in the Emergency Department? No one else.

Just for clarification, I’m talking about an electronic chart, maintained by doctors, not an “electronic health record” or “personalized health record” or any such nonsense filled out by the patient (think Google Health).

These are how my daydreams go:

  • A patient comes in to see me. I immediately get a list of their medical problems, prescribed medications, and allergies. This list is with actual real words, not “the little blue pill,” or “the white one, I take 10 milligrams — or is it 100 — 3 times — or is it two times — a day.”
  • I can see who a patient’s primary medical doctor is, and get quick access to their communication info.
  • I can see when the patient last saw said doctor, or went to an Emergency Department, or was admitted to my — or any — hospital.
  • I can talk to the patient, already knowing if they carry a diagnosis of heart failure, diabetes, hypertension, smoking — to help narrow my differential.
  • I can see if the patient just had a work-up for problem X, perhaps changing my disposition of the patient.
  • I can input orders electronically and write my chart electronically, allowing me to be more efficient and see more patients.
  • And in this fantasy world, I could even arrange for a follow-up appointment for the patient!

The technology is clearly available, but no one is ready to make — or mandate — the leap. (Hopefully the new health bill will encourage this.) I can track an airplane across the country, trade stocks through my mobile phone, and see the street where I’ll be staying at my hotel in Berlin, but I have no way of accessing the information from the hospital 15 minutes away. God bless America.

A lot of the data is clearly available, but just not accessible. One such example: I find it absolutely astonishing that the DEA can send letters to physicians that they “gave patient X a prescription for 20 tabs of percocet, when she has already received 150 tabs of percocet from hospitals in your area,” yet we as physicians are not privy to this information.

I’ve been following health information technology for several years, and everyone is separately trying to solve the problem with their own electronic medical record, their own information system that doesn’t have a standard interface to talk to any other system. It’s about time we have something agreed upon, enacted, and changed.

(And I simply don’t buy the “Computers are too hard to learn or not useful” argument. 90% of primary care physicians in “Australia, Italy, the Netherlands, New Zealand, Norway, Sweden, and the United Kingdom” use electronic medical records, while only 46% of US physicians use them.)

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  1. #1 by Jonathan Blackhall - November 30th, 2009 at 12:18

    Why would any company want to make a standard EMR when they could much more profitably attempt to corner the market with their proprietary format? There’s no incentive for companies to work together to create an open standard, and until one or two come along with a FOSS mentality, this situation likely isn’t going to change. It’s really sad because FOSS could do a lot to help this industry.

    I did a post on EMRs last year on my blog, and while some of the info was slightly misinformed (as an M2), the short section on EMR standards is still true: http://encephalosponge.com/2008/03/27/portable-electronic-medical-records/

  2. #2 by Jude - November 30th, 2009 at 21:15

    But say you’re me, a patient who has little interest in sticking around beyond a few more years. I occasionally seek medical care from a busy family practice clinic. For example, last year, I developed a weird eye anomaly, so I went to a GP who discovered that I was vitamin-deficient. I got checked up by an optometrist and discovered that the weird eye anomaly is currently nothing to worry about. The GP wanted more tests, but I didn’t return. If anyone were paying attention, they could have easily put 2 and 2 together and realize that there’s a good chance I’m still clinically depressed and suicidal; that is extremely unlikely to happen, though, as long as I just wander in every so often for a checkup. Heck, I’m 54 and I’ve 1) never had a cholesterol test 2) haven’t had a pap smear in over a decade and 3) have never had a mammogram. No one will ever notice as long as we keep the current system. No one will care. Nothing will delay my planned exit in 2 years and 7 months.

  3. #3 by sch - November 30th, 2009 at 22:46

    As to the Rx problem, quite a few states at least
    in the Southeast have on line searches that allow
    queries on patient name/birthdate to see what
    Rx they have had over the past year. Astonishing
    what can show up on these. Of course near the
    state line it likely won’t give you Rx filled in the
    next door state.

  4. #4 by EMR Specialist - August 15th, 2010 at 05:39

    I am commonly asked if physicians of various specialties should utilize a generic EMR or should they use one which has been designed specifically for their specialty.

    This is closely related to the use of a National EHR – which concept has some interesting features – but may be fraught with unintended consequences.

    An article on which features an ED EMR should have in particular may be of interest:

    http://www.emrconsultant.com/specialties/emergency-med-emr

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