News/Commentary

By Cheree Cleghorn, Editor

The “ahead” group of practicing physicians—-the so-called “early adopters” always go first.

These are the ones who see, for example, the benefits of an electronic medical record (EMR).

EMRs will enable all of a patient’s doctors to have real time information about their test results or see what another doctor did in an earlier visit with this patient.

But the percentage of physician practices which has been willing to  invest the time and money to change over from paper to electronic records has been disappointingly small, as reported in a study this year in the New England Journal of Medicine.

Watch out, late adopters!

The next generation is coming. They’re not only ready for EMRs but question how well they can practice without them.

Any practice or hospital recruiting about-to-graduate physicians should understand how important and appealing the technology is to them.

The stethoscope was one of the basic tools for more senior physicians. They would not have gone anywhere without theirs.

Computer screens are like that to these new graduate doctors.

It also must be noted that even the most enthusiastic EMR advocates say that they are not a “magic bullet.” It is still a record. The human care-giver is the one doing the work and the work will be no better or worse than that care-giver, EMR or no EMR.

Our Main Concern About EMRs… Protections for Patient Privacy

In many stories in the last couple of years about EMRs, there has tended to be a focus on the technology or the patient privacy risks.

- Funding was the first hurdle. The money for EMRs will come to practices, one way or another.

- Physician acceptance is the second. The latest graduates want this technology. If practices or hospitals want to recruit young doctors, they will have to adapt.

- Patient privacy appears to be a “we’ll get to that in a minute” item. That will be too late. The system will be built.

California’s Kaiser Permanente, the grandfather of all HMOs, pioneered a coordinated records approach much like this. That was possible because all of their members were under one umbrella organization. Their patients only received care from Kaiser doctors. Because Kaiser had plenty of time to work with and tweak a system for patient records, to the best of my knowledge, that organization must know the secrets to secure records.

However, most patients aren’t in that kind of network. They have doctors who don’t know each other, may be in different buildings or towns—-these care-givers are not part of a culture which built this approach from the ground up. News stories about computer breaches of hospital or government records are so commonplace, they don’t make the front page any more unless many, many thousands of people are affected or they had sensitive information breached.

That’s the issue. This is a fast-moving train, EMRs. That is great news in some ways and not so great in another.

To date, no one has come forward with a truly secure way to protect patient privacy with EMRs—-and the General Accounting Office pointedly criticized federal efforts on EMRs because of that problem. The development side was getting ahead of the privacy side, to paraphrase the GAOs conclusion.

There needs to be attention paid to both effectiveness and privacy in the world of EMRs.

If patients cannot trust that their most private information is secure, whom can they trust in medicine?

Patients are owed secure medical records, with careful chains of evidence about who may see them, why, when that record was accessed and by whom.

amednews

“For the next generation of physicians, information technology is as essential a tool as the stethoscope — so much so that they are uneasy when they are confronted with practicing in a paper-based environment.

“A study published in the December 2008 issue of Academic Medicine, the journal of the Assn. of American Medical Colleges, found that new physicians coming out of high-tech learning environments feel less capable of providing safe patient care when placed in environments with less health information technology.”

The story quotes one representative doctor in training.

….”David M. Nestler, MD, in his second year as an attending emergency physician at Mayo Clinic in Rochester, Minn., said he is fortunate that everywhere he has worked has had some level of electronic medical records, although at varying degrees.

“He said health IT is one of many factors in choosing where to practice. “But I wanted to make sure that any place I worked had some level of electronic medical records, because I feel it’s much easier to obtain medical histories, know what critical medications the patient uses, and get more timely answers and timely results to tests we order if we have some type of electronic system.”

“The Vanderbilt study found that 24.3% said they agree and 47.1% said they strongly agree that they miss having the availability of an electronic medical record.

“Dr. Nestler said that he could work without health IT, but it wouldn’t be his preference.

“I would compare it to this: Once you are used to communicating with family by e-mail, it’s hard to go back to pen, paper and stamps.”

Source: amed news, December, 29, 2008 (Online), January 5, 2009, (Print)