EMR selection: proceed carefully

March 1, 2007

EMRs' promise comes with a downside, Dr. Siegel notes. Would people want all this information out there if encryption and security mechanisms ultimately chosen as standards prove insufficient?

With that in mind, he recommends putting at least as much homework into selecting an EMR system as one would put into purchasing a house or car.

Regarding EMRs, "Probably the most critical thing for people to know is that as of 2014 - the date President Bush has set for the majority of American patients to be covered by electronic health records - they're going to be in one's office, whether one likes it or not," says Daniel M. Siegel, M.D., clinical professor of dermatology, State University of New York (SUNY) Downstate, Brooklyn, N.Y.

Good with bad

EMRs also possess much potential and many potential pitfalls, Dr. Siegel explains.

Cornerstones of EMR systems include Continuity of Care Records (CCRs), which are intended to compile snapshots of every patient's useful and possibly lifesaving health data in a standard XML-based format, Dr. Siegel says. Personal Health Records (PHRs), on the other hand, refer to medical information individual patients or their caregivers can carry at all times in paper or electronic (or some combination) form, he adds.

"The concept behind CCRs and PHRs is to give the patient and all providers access to these records anytime, anyplace," Dr. Siegel notes.

Currently, he explains, other doctors won't have his patients' records unless he forwards them for a referral or other purpose.

"That's not usually a problem for elective care," Dr. Siegel says, "but if a patient from out of town is urgently ill and presents at an emergency room, wouldn't it be great if the ER doctor can simply look up" all the patient's key information on the spot?

He says the United States military is working on incorporating such information into USB port-equipped dog tags. Radiofrequency identification (RFID) chips in jewelry or an ID card may serve a similar purpose, he adds.

However, EMRs' promise comes with a downside, Dr. Siegel tells Dermatology Times.

For example, he says, "Would people want all this information out there" if encryption and security mechanisms ultimately chosen as standards prove insufficient?

Somewhat similarly, he says that although the technology to make universal EMR a reality exists today, "The problem is making the technology palatable and user-friendly."

Software programs such as Word (Microsoft) and Quicken (Intuit) have found favor with the vast majority of computer users because they extend processes people already were doing, such as typing on a keyboard, Dr. Siegel observes. However, he says there's no equivalent "killer application" for EMR, largely because all doctors handle medical records differently.

"Some people have always dictated and then typed these; others work from diagrams or cryptic longhand notes," Dr. Siegel says.

At the same time, he says today's electronic medical records include such exhaustive detail that each visit can generate "pages of notes and discussion."

While such records have evolved to meet growing documentation needs, he allows, "Sometimes we get buried in the data. A healthy patient's chart might include an inch-thick volume of paper - what can one tell from that?"