Disruptive Technology of Electronic Medical Records (EMR)

Disruptive Technology

Information Technology/healthcare

Disruptive technology: Electronic Medical Records (EMR)

Disruptive technologies can create both positive and negative changes for the healthcare environment. One of these changes is the shift to electronic rather than paper-based medical records. On one hand, the superiority of electronic medical records has been widely acknowledged, given the extent to which the technology can promote accurate and complete patient records. On the other hand, there still remains profound resistance to the implementation of such methods of recordkeeping. For many healthcare providers, the need to rely upon electronic data represents a profound loss of control over how information is handled. Many institutions are also resistant to the cost required to implement electronic recordkeeping.

The shift to electronic recordkeeping has been a long, slow process. Yet there are many acknowledged benefits in using EMR. One of the most obvious is enhanced legibility -- the incomprehensible nature of doctors' handwriting has long been a butt of jokes, but can have serious consequences if patient diagnoses or medications are not properly read (Tennenhouse 2010). Typing in a computer reduces the risk. There is also enhanced sharing of records between providers. Many if not most patients see more than one healthcare provider, such as a GP and a specialist -- or they may see a physician on vacation or be taken to the emergency room. With electronic data-sharing, every provider that treats the patient can be aware of the patient's health history, allergies, and previous conditions (Tennenhouse 2010). Patients can also benefit because it is easier to follow-up and monitor for patient compliance. They can also be notified if their medicines are recalled, or of other critical data.

However, many physicians are profoundly resistant to EMR, despite these many benefits. "Adoption of EMR currently limited to only 5-10% of medical practices" (Koriwchak 2010). In general, doctors and nurses are not 'computer nerds' by nature and do not like ceding control to a computer program, nor do they wish to devote tedious amounts of time to learning how to deal with an electronic program in general. The use of EMR can be cumbersome, involving a "multipage, single-spaced, small font monster of a chart note with very little substance relative to its size" to record CPT codes or "elaborate documentation requirements that medical records must fulfill in order to receive payment from the insurance provider" (Koriwchak 2010).

Another barrier to implementation is cost. Because of the perceived benefits of EMR, the Health Information Technology for Economic and Clinical Health (HITECH) Act offers financial support to practices that implement EMR. However, a recent survey found that one in five physicians did not know about this incentive program. Smaller practices also often feel that because of their limited patient size, even with financial assistance from the government it still does not behoove them to use EMR. "Even the potential bonuses from meeting meaningful use requirements -- up to $44,000 over five years from Medicare, or nearly $64,000 over six years from Medicaid -- or the penalties doctors who don't meet the requirements may face from Medicare beginning in 2015, aren't enough to convince small practices that an EMR is worth the effort" (the resistance: Small practices reluctant to implement EMR, 2012, Hit Exchange Media).

Training staff members requires additional costs. There is also the 'time' cost of using the system on a daily basis. Furthermore, many find the demands of using the system -- typing into a machine as the patient talks -- to be profoundly impersonal and contrary to the true nature of practicing medicine. Doctors and nurses want to focus on people, not on machines, and they view EMR as a machine-driven intrusion into the way they practice medicine. However, supporters of electronic medical records contend that it is this desire to ignore the mundane side of medical record-keeping that often results in bad medicine. The great advantages of EMR are that they do require that providers enter all relevant data and ensure that patients sign necessary request forms. And patient health as a whole will be improved if by using EMR, there can be comparisons made between different patients. Data trends will become more readily apparent, complete, and easy to compare (Tennenhouse 2010).