|
Electronic Medical Records, or
You Can Never Find An Ancient Greek When You Need One
Wayne Webster
Electronic Medical Records or EMRs have received a lot of press in the past year. Hundreds of millions in stimulus
money flowed to the development of EMRs with the expectation that EMRs will bring down the cost of health care. I
guess time will tell whether they will realize their full potential for health care cost reductions.
When you read what is being demanded by our Government as an EMR standard it isn’t exactly what most users are
seeking. Over the past year I’ve spoken to many practices and followed the many articles about EMRs. Most centers
ask the same questions when imaging equipment is installed. How do I get the information from this imaging device
into a form that can be used with my PACS system? Or, how can I access the data to produce a report?
No one asks how do I share this data with others? Or how do I attach this information to the patients total access
medical record? No one is overly concerned about how the information becomes accessible to folks outside of the
practice or hospital. They’re just seeking basic connectivity and standardization of image and report formats.
The prediction of cost savings is based on EMRs being readily available on the WEB. Everyone claims to understand
that EMRs for any patient have to be available to all providers of health care if we are to avoid repetitious or
unnecessary testing when a patient presents with a medical issue.
Perhaps knowing a little about the historical development of medical records will assist us in predicting the potential
for EMRs to reduce health care costs. Medical records have taken a circuitous path since their inception in the 19th
century. I recently read Stanley Joe Reiser’s book, Technological Medicine, The Changing World of Doctors and
Patients. You can find it at Amazon for $17. Unlike other books of this type Reiser’s focus is not about amazing
technology and how it works. Rather starting with the stethoscope he explores how the introduction of technology
alters the doctor patient relationship. The history, the observations and his predictions are thought provoking.
He devotes a chapter in the book to the development of medical records and today’s call for EMRs. Here’s what I
learned from the chapter. In the 1800s there were few hospitals and most doctors were poorly trained and not
associated with a medical facility. Point in fact most doctors in the early part of the 19th century believed working in a
hospital was beneath their position. Medicine was an art, not a science. They (the doctors) treated their patients in
their office or at the patient’s home. They listened to the patient and decided on a therapy based upon the patient’s
description of the problem. Today we’d say that’s a risky way to practice medicine.
It was in the second half of the 19th century when hospitals began to appear in larger cities and in greater numbers.
Doctors began to make use of hospitals and from this use the demand for medical records grew. When initially asked
to produce regular and formatted patient medical records doctors were outraged by the request. They didn’t need to
keep written records. They kept the information where it belonged, in their heads. And they claimed total recall.
This total recall was tested now and again and the results were less than remarkable, as you might imagine.
With the result in that doctors couldn’t keep records in their heads and as hospitals became more prevalent,
administrators began to demand doctors prepare written records for each patient. This was not specifically done to
allow for service billing, it was so that if the patient returned with more issues someone might be able to tell what
happened during the last visit. If you think about it the reason for patient medical record keeping hasn’t changed
much in 200 years. Nor has our need to retrieve information about the patient and the services provided changed
over this time.
As you can imagine with doctors not seeing a value in written medical records the early ones were almost useless.
Doctors wrote less than helpful observations and frequently the record was illegible and inaccurate. As time passed
individual hospitals set standards for medical records and doctors became better at recording patient history.
Storage and retrieval of the records became an issue as the physical number of records increased. Sharing of patient
records between institutions was virtually impossible as it is today. The hospital had its records, the doctor had his
office records and possession was nine tenths of the law.
So in the 1800s we have the need for record keeping, storage, retrieval and sharing. Sound familiar? With the
continuing passage of time medical records increased in size and with the addition of information more disparate
groups wanted the data within them. Government regulators, finance, researchers and others concerned with the
occurrence and effective treatment of disease all wanted information. This demand for information shaped the
medical record into what it is today, a tool that serves many masters.
Reiser speculates about the value of today’s medical record and its ability to bring down the cost of medicine by
sharing the information it holds. He says with so many different groups driving the collection of statistics the record
becomes less useful as a tool for understanding the patient condition and making more cost effective decisions.
Here’s a recent personal experience. My wife was in the hospital for an emergency situation. Her doctor attended
along with others. Over three days there were tests and visits by specialists along with visits from her doctor. When
she visited her doctor’s office two weeks later for a follow-up, she was asked to repeat the symptoms that brought her
to the hospital and what happened while there.
Her doctor’s office is connected to the hospital. I suspect the records were available somewhere, but at the time of the
visit it was easier to let the patient provide the information. As Reiser opines in his book this method of practicing
medicine dates back to Hippocrates and isn’t very reliable. Although centuries later, we still practice medicine as
Hippocrates did in ancient Greece. Now it’s just easier to dictate on electronic media rather than having to make your
own papyrus paper before taking notes.
Will EMRs save the day and allow for a cost savings in the delivery of health care? I don’t know. I do suspect the
development of EMRs will keep a lot of programmers working for many years developing several solutions to this
problem. Unifying the collection, organization, retrieval and sharing of the information may be out of reach for the
time being.
We have the computing power and the bandwidth to make this happen. But that doesn’t mean we have the will or the
interest in making it happen. Although we have lots of technology, when you break it all down to its base components,
the art of health care hasn’t changes much since Hippocrates trained his first group of physicians.
|
