December 2004 Bulletin

Are EMRs a good fit for your practice?

Take your time in moving from paper records to electronic data

By Robert F. Jones, MD

Imagine instantaneous access to a patient’s medical history from any Internet portal. These electronic medical records (EMRs) would contain accurate, up-to-date and complete information on all previous medical encounters, including lab results, diagnostic studies and consultation reports.

The data would be easily sorted and filtered, allowing for effortless creation of problem and medication lists. Orders would be automatically checked for safety and accuracy, and routed to the appropriate location (pharmacy, lab, radiology, etc.).

The push for health care IT

The technology necessary to achieve this information utopia (or Orwellian nightmare) is currently available, but medicine lags far behind many other industries in implementation. This delay has caused a public outcry because errors and omissions in the delivery of medical care can have catastrophic consequences. Studies have shown that nearly 100,000 preventable deaths occur yearly in hospitalized patients. Medical errors also contribute significantly to increasing healthcare costs.

The federal government has become involved, with President Bush recently calling for the creation of electronic medical records for “most Americans” by 2008. The private sector is also mobilizing, with insurance and industry groups spearheading initiatives that favor hospitals and groups that incorporate information systems in the delivery of care.

However, for EMRs to reach their full potential they must be accessible to all EMR systems, a challenge in a country where about 75 percent of health care is delivered by physicians who are not bound to any particular data entry and storage standards. Several medical groups, such as the Massachusetts Medical Society, the American Association of Family Physicians and the American Academy of Pediatrics, have been working to set national standards toward creating a completely integrated EMR system. Although these groups and others have made progress, the standards are still in development, rendering them risky to incorporate in today’s EMR packages.

Is it time to take the plunge?

The move from paper-based to electronic medical records is inevitable, but with the market so young and standards yet to be established, is now the time to commit the time and money necessary for implementation? Here are some issues to consider in making your decision:

It takes careful evaluation and a significant amount of time (6 to 12 months is typical) to determine which EMR is the best fit for your practice. Many companies are reluctant to release price information unless they are able to do on-site or Web-based demos, which can be confusing and very time consuming. These systems are frequently very complex, and a lack of in-depth insight into the software and technology can make decisions extremely difficult.

If after considering these factors you do decide to implement an EMR system, you should quickly realize several advantages, such as improved access to patient information. Many EMRs allow for data entry at the time of examination and delivery of care, eliminating the lag time normally seen with paper charts and dictation turnaround. Legible prescriptions can be faxed to pharmacies. Charts are not lost, and people at different locations can view the same chart at the same time. This is especially beneficial in larger practices with multiple sites and in practices where the providers or staff sequesters charts that are not completed in a timely fashion. Functions such as medication compatibility alerts, accuracy and completeness of medical history, and access to diagnostic studies can be used to support the contention that EMRs improve quality of care.

How’s your bottom line?

Less certain are the effects on a practice’s bottom line. Many EMR companies attempt to justify the cost outlay by claiming significant return on investment. The claims usually fall into two categories: increased revenue stream and decreased overhead expenses. It can be very difficult to determine if your practice will realize these benefits. Consider the following:

A final suggestion

Whether an EMR will ultimately succeed in your office depends, to a great extent, on how intuitive and efficient it is for the user doing the documentation. As a result, it is extremely important to have a clinician, already computer-savvy if possible, involved early and extensively in the selection process. It helps to calculate the time you currently need to document new and follow-up patient encounters. Be certain to visit a practice already using the system that you are considering, and carefully evaluate how their documentation time compares to yours.

Robert F. Jones, MD, is an orthopaedist in private practice in Leominster, Mass. He has designed and built two EMR systems for office use. Dr. Jones can be reached at

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