Electronic Medical Records: The Good, The Bad and the Ugly

Posted on Wednesday, May 15, 2019

Despite the widespread adoption of e-mail, bar code scanning, easy electronic data transmission, realistic bandwidth levels and cheap storage of electronic information, we haven't yet seen much reduction of costs. It's not for lack of throwing money at the problem. Congress has expended some $6.5 billion on health care digitization technologies in an effort to help health care organizations, insurance companies and other stakeholders adopt modern technologies. The goal: Reduce or eliminate the potential for human error to drive up costs, drag down care quality and outcomes and endanger patients.

What's holding us up? Data entry is a big part of the problem. It's not hard to transmit data once you have punched it into the system. But the easier you make the data entry process, the more you corrupt it. For example, some data capture solutions have generic templated, prewritten passages in a menu-driven data entry system. This makes it easy to input data generic patients. But patients aren't generic. Thus the temptation is always there to fall back on templated, preapproved language in treatment plans and diagnoses that will not be questioned by insurance companies, rather than make the data entered be a true reflection of the patient's individual, unique circumstances. Deviate from the norm even a little, and office managers fear they will create reimbursement problems as insurance claims officials balk at paying benefits.

Moreover, the IT departments at many health care institutions, both public and private, have been struggling with implementation. For example, the new emergency medical services system in Contra Costa County (located in California) essentially crashed their IT system. The new program slowed down the system so much that it actually cut the number of patients Contra Costa County doctors could see by 50 percent.

Advantages

For all the difficulties, though, there have been some marked benefits of the migration to a digital electronic medical records environment. For example, patients can now see their own medical records on a mobile device — a valuable check against error. And while pull-down menus for data entry are imperfect, they are at least legible. Medical error is the 6th biggest killer in the United States, responsible for between 44,000 and 100,000 deaths per year. The notorious illegibility of doctors' handwriting is a major contributor. Another key contributor is drug interaction. If a doctor treating an incapacitated patient in a crisis does not know what the patient has been taking, an unexpected drug interaction, combined with existing stressors, can be lethal. A modernized medical record system can bring all of a patients' existing prescriptions to an ER doctor's fingertips in seconds.

So while we have not realized much in the way of cost saving potential from the electronic medical records revolution, there are other worthwhile benefits to be had, too. Critical detailed information can be made available, regarding such things as a patient's medical history, allergies, and even information or instructions regarding end of life care, such as living will information.

There is more to come in the future of electronic medical records. Time will tell if we'll see significant reduction of costs, but this may be one area where the true benefits will always be non-monetary.

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