“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care” – words of a lawyer, insurance executive or doctor? No, it’s a statement made by President Bush in his January 2004 State of the Union speech.
The mid-1970s development of computer-generated electronic medical records (EMRs) is revolutionizing the age-old patient management tool: manila folders brimming with reams of paper, which doctors and nurses must fumble through to find information. Worse yet, patient charts have often been misplaced – even lost – which compounds problems and, on occasion, compromises life-or-death healthcare delivery decisions.
Because of the age of computers, the Information Superhighway, the High Performance Computing Act of 1991 and the Information Infrastructure Initiative of 1993, EMRs have become the “tool-du-jour” in medicine.
A major federal initiative – the National Health Information Infrastructure (NHII) – aims to create a coast-to-coast network in which patients, practitioners and hospitals, will have “access to content held in multiple places, so that the right information is available to the right person at the right time and in the right place,” according to the National Committee on Vital and Health Statistics, an advisory group to the U.S. Health and Human Services Department.
The events of Sept. 11, which heightened bioterrorism awareness and its threat potential, underscored the importance of the NHII and of EMRs. Added to the mix is the U.S. Defense Department’s testing and movement toward deployment of EMRs for its 8.5 million active and veteran military members and NASA’s exploration into using EMRs for its employees.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is only now being implemented and enforced, seeks to protect patient information from undeserving eyes – something hard to do in paper form, but easy to ensure electronically.
Less than a decade ago, only a few computer-oriented businesses offered emerging technology to meet the fledgling need. Today, though, dozens of companies have hopped on the marketing bandwagon promoting and selling hardware and software to electronically manage every aspect of patient care – from check-in, to check-up, to check-out – while looking to eliminate the age-old manila folder with multi-colored tabs.
Nevertheless, the switch from paper to paperless has been slow to catch on in Nevada, where EMR use is even less than the national average of 5 percent. “The vast majority [of medical facilities] are still keeping patient records the old-fashioned way, but I’m all for it; it’s a great idea,” said Dr. Edwin Kingsley of Comprehensive Cancer Centers of Nevada, this year’s president of the 895-member Clark County Medical Society. “I don’t know why we haven’t encountered any progress here, but I’m sure it will come.”
In Reno, Darlene Galleron, executive director of the 445-member Washoe County Medical Society, said she hasn’t heard anything about local doctors using EMRs, but speculated some may be using paperless systems.
In nearly every case, laptops and PDAs loaded with template-based software are being used. However, these pre-designed, pre-formatted forms and drop-down menus that display detailed patient information in a “rigid” pre-determined reporting format, leave no option for inputting special or additional information.
Template-based software, despite its promise to eliminate bulky charts, still requires writing by hand or tape recording verbal notes that have to be transcribed and printed, leaving that paperless chart filled with paper.
Now, wireless tablet PCs have burst onto the scene, making the next level of software – like that being produced by Las Vegas-based Virtual Charting – a set of digital, picture-like writeable images accessible anywhere, anytime.
The future of EMRs is dynamic and evolving. It is expected to give patients the lifetime opportunity to globally access records for better and safer care and will dispense with a doctor’s most troublesome question – “Now where did I leave that chart?”