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Electronic medical records or electronic health records — EMR or EHR — have been shoved down our throats since the early 2000s and pretty much all doctors hate them. We were sold a promise that the EMRs were going to make life better for the patients and the doctors. The EMRs were going to make healthcare more streamlined and efficient while making the patients healthier. They were going to cut down on medical errors and redundancy in ordering. Almost none of this has occurred with electronic records.
Electronic health records were being developed as early as the 1970s but mainly on large mainframe computers and for use in medical research institutions. As personal computers became practical in the 1990s, the push began to move healthcare toward electronic records. By the 2000s we were being told that electronic medical records were not only desired but soon would be required and if you didn’t adopt this new method then you would be hit with fines.
Early on it sounded like a great idea. Plug your clinic or hospital into an EMR and you would make healthcare better and safer for everyone. By putting in patient medication lists and allergies it would mean fewer prescription errors. Having lists of all the patient’s previous diagnoses and surgeries would make us better-informed clinicians. Having quick, easy access to a patient’s historical lab results and vital signs meant we could more easily tell if the patient was in better health or worse on any given day we were seeing them. We wouldn’t have to re-order tests that were just done by another facility because they would be right at our fingertips. The EMR was going to be so easy to use that doctors were going to be able to see more patients with less hassle. We were going to have more time in our day. The biggest lie sold to doctors was that the systems would all talk to each other across the country.
So here we are 20 years later and we’re no better off with EMRs and we are spending big money on them. Finding information, good information, on the use and costs of EMRs is sparse and inconclusive. Implementing an EMR for a physician can cost $160,000. Centers for Medicare and Medicaid spent more than $30 Billion dollars in financial incentives to over 400,000 providers to get them to adopt an EMR. But these federal dollars were only available to providers who had EMR systems that the government OK’d. In 2017, hospitals in North America spent $12 billion dollars on EMRs.
All this data needs to be protected too if medical practices are to adhere to HIPPA regulations regarding protecting patients’ medical information. We have a right to have our healthcare information protected, but all that protection costs money too. TrendMicro reported in 2017 that each year cyberattacks on hospitals and clinics health records cost the system $6 billion dollars and each individual breach costs a hospital around $2.1 million dollars. The average hospital spends about $12.5 million a year on cybersecurity. All these costs get passed along to us.
What do we get in return for all this spending? Some studies indicate hospitals using EMRs have shown a decrease in fatal medication errors and a 0.7 reduced mortality rate. Doctors offices using EMRs with reminders do a better job of vaccinations and blood pressure control. Asthma patients show better adherence to their medications when their doctors use an EMR. The problem here is that the results are all over the place and it’s hard to find reliable data.
What are we not getting for our money? This is easier to identify. We most definitely aren’t seeing the systems integrate so the promise of having our medical information easily accessed by different doctors across the country has not happened. Using an EMR system made it easier for a doctor to achieve higher levels of billing but that only lasted a few years. Now insurance companies want to do away with that system of billing so they can pay doctors less. Doctors spend significantly more time doing data entry into an EMR rather than spending it with the patient. This makes doctors and patients less happy and just adds to the time a doctor must spend at the office. We aren’t getting more protected as our information is always at risk of a computer breach. The biggest thing we haven’t done yet is prove that EMRs make patients healthier.
I know this article wasn’t about disease this week but I wanted to explain to you patients out there some of the struggles we doctors deal with. The EMR has been nothing more than “death by a thousand clicks.” It has been a bridge to nowhere. This isn’t to say it’s a bad idea. I actually love the idea, but as is often the case with new technology, implementation has been less than perfect. I think one day it will be good for us all but right now we are suffering. So next time you’re in the hospital or clinic and you’re wondering what is taking so long you’ll know that it’s quite possible a doctor or nurse fighting with their EMR.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
