Electronic health records: Panacea or problematic?

I’m a big supporter of electronic health records (a.k.a. EHR, electronic medical records, EMR, personal health records, PHR, and on and on).  The benefits are too many to do it justice in this short post, but efficiency, error control, speed, automation, and interconnectivity are among some of the most desirable aspects of the technology.

But is EHR / EMR all it’s cracked up to be?  Are there reasons NOT to adopt?  Are electronic health records for everyone?

The answers to these questions depend on who you ask, but in an effort to persuade you that I am [attempting to be] unbiased in my opinion, let me disclose to you that our company is, in fact, in the EHR business – yes, we provide EHR / EMR solutions for healthcare practices.  And, yes – we don’t think it’s for everyone (at least not right now).

First off, electronic health records can be expensive.  And while the long term savings associated with EHR / EMR implementation overwhelmingly pencil out very much in favor of the technology, cash flow is undisputably a more real issue over the short term.  Hence, regardless of the long term advantages to EHR / EMR, if the numbers don’t support it over the short term, it simply won’t work.

Now, this is not to say that many web-based and/or software-as-a-service (SAAS) models out there don’t mitigate this issue quite effectively – they do.  But you get the point – if you don’t have the cash, you can’t benefit from the technology.

Second, and perhaps much less understood, electronic health records can be painful.

What, you say?  The Obama Administration has included greater than $20 billion for EHR adoption in the stimulus package, and EHR’s are painful?

Yep, absolutely.

EHR / EMR use is different than using paper.  It’s better in a number of ways, but for anyone who’s ever made the quick decision to write a phone number down on a Post-It Note rather than logging into their smartphone, navigating to the contacts menu, creating a new contact, and then punching in the number on tiny little keys, you’ll know what I’m getting at.

Using EHR / EMR in many circumstances – especially those in which the provider has to peek over the top of a computer screen in a cramped little office just to make eye contact with their patient – is awkward.  It’s often not as fast as jotting down a note, and it’s certainly not as natural.  Hence, it’s often difficult to get buy-in from providers.  And hence, the pain.

If not managed well, the transition to electronic medical records can be an outright disaster.  In my opinion – the opinion of a web-based EMR provider – if the transition is not going to be managed correctly, EMR / EHR is not for you…at least not now.

Managing the transition correctly means educating the staff on which aspects of care WILL be different, getting buy-in from EVERYONE in the office, and having the technical support AVAILABLE to deal with issues as they inevitably come up.

OK, enough of my short little rant on the topic.  Here is an insightful post from the Wall Street Journal that takes a look at the issue, citing other problems with EMR / EHR usage, including mention of a study that explored a rise in the death rate for certain patients after the adoption of an EMR / EHR system at a pediatric hospital.  Scary, but true.

At the risk of sounding contradictory, I’d like to end with this thought – electronic health records ARE our future.  We will all have them, use them, and rely on them more and more each year.  Are they a panacea?  No – not in my opinion.  Should we adopt them now?  Yes – if we can find the financial and operational resources required to keep the doors open to our practices while administering a safe and organized transition to the technology.  EMR / EHR has too many benefits to count, but it MUST be done correctly.

[Front-page image courtesy of Flickr user Southerntabitha]