Electronic Medical Records – Past, Present, and Future?

Dr. Donald Voltz, MD, discusses how today’s electronic medical records are merely a duplication of the past and how future EMR systems must align medical professionals with collaborative data. 

The open question regarding Electronic Medical Records (EMRs) is what they now offer the medical community and what would medical professionals need and envision for the next generation.

The Henry Ford adage: “If I had asked people what they wanted, they would have said faster horses.” This quote has been used to counter criticism from physicians concerning EMR adoption and use. This would be a more solid argument if EMR’s brought novel and impactful power to healthcare delivery, but today’s EMRs are nothing more than the electronic duplication of the medical record that has existed since the 20’s.

Having personally used the three largest EMRs, I am amazed at the errors present in the systems and the use of duct tape solutions, such as scanning paper records into the system rather than integrating with other healthcare systems. The most widely deployed hospital EMRs are built upon database technology from the 1960s. The user experience with patient data entry and access to that data for care management is rudimentary at best.

Expectations should be more significant, as these systems cost hospitals millions of dollars.  The cost of replacing the current system when other advancements arrive is one possible solution, but this is not likely for hospitals due to the costs involved.  Looking for solutions that can offer a collaborative way to connect all of the proprietary data models while focusing on interfaces that enhance patient and physician usability seems to be a better solution.

Physicians, patients, and the healthcare industry should expect EMRs to at least support physicians and other healthcare providers in accomplishing their goal of taking care of patients. Unfortunately, many social media platforms offer far more usability and access to information than EMRs while maintaining data security and integrity.

Many new technologies will be developed and applied to these systems, but we need a better solution than proprietary companies completing all of the EMR development.  EMR vendors need to integrate around collaborative connectivity hubs like the nurses sheet many of us used. Too much is at stake for hospitals to maintain all these legacy systems; we must, as an industry, look for new ideas.  Sure, workarounds are being employed to address the deficiencies in these systems. Still, most are not ideal and result in higher costs to systems that were touted to reduce care delivery.

Related: Can EHRs Achieve the Interoperability We Need? 

Medical Scribes Are Not the Answer

The most concerning issue regarding EMR productivity is the use of medical scribes. Using these systems and the requirements for physicians to enter large amounts of patient information decreases their productivity and reduces direct patient contact time. There is no practical way to reduce the amount of patient information, so physicians employ medical scribes to enter data, which opens up more time for patients.

This trend will increase the cost of healthcare and reduce the original premise that EMRs would increase physician efficiency. A better-designed system would enable practitioners to customize their documentation to the workflow they have found most effective and efficient.

Coping with EMR Scavenger Hunt

An ability to connect with a single interface, irrespective of the EMR, would improve my day-to-day patient care and create standardization for where EMR information is stored. Currently, I have to look in multiple places within EMRs to gather all of the relevant information to manage a patient’s complaint or condition. This reminds me of a scavenger hunt, not the well-designed dashboard that was promised.

Instead of identifying the problems of paper-based medical charts and developing tools to overcome their limitations, we added technology to the same paradigms. This only resulted in improved readability but not an improvement in how physicians access the information of these systems.

Switching between different locations to gather vital sign information, review past medical history, and perform laboratory studies is not only manual; data can be entered in different ways, depending on the healthcare provider who entered the information in the system. Switching between views, using a non-standard interface, and using scribes to enter information will continue to prevent the real advances EMR technology needs.

Related: Why Physicians Will Never Ever Like EMRs and How to Change That

Lack of Communication

The medical record is a log of patient data, the thoughts of physicians and other healthcare practitioners, and the care delivered. It is, above all, a means of communicating with one another. The EMR, being closely modeled to the standard paper-based medical record, serves these purposes with the promise of improving oversight and error detection. The potential reach of the medical record extends far beyond that of its paper predecessor, and once the interoperability issues have been addressed, more value will be added.  However, its use as a communication tool has not yet extended beyond paper. Although remote access capabilities exist, these do not make it an enhanced communication tool.

A medical record user still has to search through the information it contains.  When a piece of information is not present, the user cannot know if it is not yet done, an order was missed, the data was never entered, or it was entered into a non-standard area of the medical record.

When information is not acted upon, these issues can cause duplication and medical errors. Most everything done in healthcare requires action, be it the request for specialized consultation, the ordering of labs or tests, or the interpretation of nursing notes and vital signs. However, EMRs often do not indicate when a piece of information has been assessed and possibly acted upon.

Related: What is the Future Role of EHRs in the Health IT Ecosystem? 

“Smart” Hub Collaborative Data Needed

We need a system to align medical professionals with data that is collaborative, not passive, and includes analysis with the right data delivered to those who need it, when they need it, with all the data in one place. Systems that make the data “smart” through collaborative platforms that can analyze and interpret the data.

What I find frustrating is that this technology exists to make EMR’s a communication platform that can embrace standard technologies that have been validated in other areas such as finance that push information out to physicians and others who are caring for patients. Reversing the need to search for necessary information and replacing it with push technology would make EMR’s more useful and efficient for everyone.

I do not expect perfection on the first iteration, but I would like to see early adaptors be able to add customization or develop tools that could enhance these systems. Those of us working in the trenches to improve our patient’s experience from a safety and quality standpoint need the ability to develop on top of existing systems. I know many innovative physicians who could bring change if tools and interfaces into EMR’s were available.

I fully understand the issues with securing and protecting patient information. We have developed much experience in accessing and sharing information between systems. Standardized protocols exist for transmitting information, as well as systems to evaluate and certify technology prior to release into clinical care.

Imagine what a platform such as Apple’s App Store would have in the area of EMRs. Harnessing the frustration of physicians eager to learn about and develop tools to enhance EMRs would expand functionality. Granted, many less-than-novel applications would be developed, but there would also be some blockbusters that would revolutionize electronic documentation. Healthcare, like every other business sector, has a subgroup of innovative explorers who embrace the current frustrations and barriers to find ways to overcome them. I am just one.

Related: Looking Beyond the EHR: Know Your Data, Control Your Story

This article was written by Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  Thanh Tran, CEO of Zoeticx, Inc,. also contributed.

Dr. Voltz is a board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, he has been involved with many facets of medicine. He has performed basic science and clinical research and has experience translating ideas into viable medical systems and devices.

photo credit: Yann Ropars via cc