Ask not what the EMR can do for you, ask what you can do for the EMR.

imageThis month I’ve been mainly hanging around my office on the Microsoft campus in Redmond. Since October and November will be heavy travel months, I’ve been taking care of all the little things I never have time to do, or can’t do, when I’m on the road. One of those tasks has been catching up on some overdue health check-ups including an annual skin exam by my dermatologist, and a vision check by my ophthalmologist. Both doctors practice in private clinics with a few, same-specialty partners. Both doctors are also in their mid to late 50’s. And, neither of these doctors or their partners are using electronic medical records.

On the other hand, my primary care doctor is a forty-something internist affiliated with a very large healthcare organization that is headquartered in Seattle. He’s been using an electronic health record from a major, well-known vendor for several years now. I also have an upcoming appointment with him and, just like every other time I meet with him, he will no doubt spend most of my appointment grousing about how much he hates using the EMR.

Mind you, these doctors are not technology luddites. My dermatologist teaches at Stanford. My ophthalmologist is a gifted eye surgeon. However, despite the availability of federal incentives to help pay for an EMR, neither doctor has been able to identify a system that would work well enough for them to take the leap. Both doctors feel that an EMR would only slow them down and get in their way in the exam room. 

imageAs for my general internist, he’s only made peace with his EMR by delegating most of the data entry to medical assistants. This is perhaps contributing to another problem. His organization has recently offered an on-line patient portal. The portal lets me correspond with my doctor, make appointments and view my medications, lab results, and a summary of my medical record. My eyes were really opened when I signed on to the patient portal and looked at my “medical record”. God forbid anyone, especially my insurance carrier or another doctor, would form an opinion about my health looking at that summary. It’s not that the conditions mentioned never happened, but it seems every time I have reviewed my medical history with the medical assistants who enter data into my record, these things are recorded as new events. If I had had as many procedures, biopsies, and health events over the last few years as this “record” suggests, I’d surely be dead by now. So much for the superiority of electronic records, or put another way, “garbage in-garbage out”. 

Recently there’s been a great deal of debate in the medical literature and lay press on whether or not the US government’s $30 Billion (and counting) investment in electronic records is paying off by making healthcare safer, more efficient and therefore less costly. I appreciated reading a well written editorial blog on the topic by Dr. Ashish Jha, a physician, health policy researcher, and data advocate. Dr. Jha proclaims that most studies on the value of health information technology are asking the wrong question. The question should not be if electronic records are worth the cost or if they improve quality. The question should be, How do we ensure that EHRs help improve quality and reduce healthcare costs?  

On that point I totally agree. I know for a fact that my dermatologist and ophthalmologist would like to be using an EMR. Neither doc would say that a paper record is superior. I also know that my internist, as much as he detests the EMR he is forced to use, would never go back to paper. Our focus must instead be on how to make clinical computing a better experience for clinicians and for patients. I am optimistic that with the launch of Windows 8, Microsoft Surface, Windows Phone 8, and an amazing array of new computing devices from our partners, that clinicians will be able to find devices and data input options that are a good match for clinical workflow. I am also optimistic that advances in speech recognition and natural language processing will make it easier to turn clinical dictated notes into structured data. Furthermore, advances in cloud computing and solutions for “big data” will provide insights and understanding about what we do in medicine as never before. Finally, in an age where “there’s an app for that”, I believe that medical specialists like my dermatologist and ophthalmologist will be able to find software solutions that actually fit their unique needs and clinical workflow.

This is the beginning of a new age in clinical computing. We still have a long road to travel, but I’ve never been more excited by what we can do.

Bill Crounse, MD Senior Director, Worldwide Health Microsoft

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