Should we care about EMRs?

Electronic Medical Records (EMR) are getting much press these days, especially since the Bush Adminstration is pushing them as a core of the NHII (National Health Information Infrastructure) in the second term agenda. HHS set aside $50 million for EMR projects in 2004 and included $100 million for such projects in its 2005 budget. Everybody seems convinced that we could save billions of dollars and thousands of lives if only we had electronic medical records in place. While there is some truth to the fact that creating electronic records from patient data would have significant benefits, my roughly 10 years in the healthcare IT industry leads me to believe that the numbers people have come up with are not only unproven but may be dangerous to cite because they imply that information technology somehow creates better healthcare (and not better doctors, more experienced nurses, better management of secondary infections, etc).

Nevertheless, given that there’s so much interest in EMRs these days I figured I would jot down some variations of EMR definitions.

• One definition of an EMR is the traditional paper chart (clinical information) moved into some electronic form.
• Another definition of an EMR is a reworked healthcare workflow where doctors and nurses enter orders and notes in a computer instead of on paper.

Ultimately, the proper definition is meaningful if we try to figure out what an EMR is supposed to do:

• A clinical data repository – pull together clinical data from various sources, consolidate it, organize it, convert all the disparate meanings so that they are semantically similar or identical, and then provide an easy way for clinicians to use it to make better clinical decisions and have the computer help them do they couldn’t do before.
• A physician or caregiver workflow tool that helps them gather more meaningful and actionable medical data than they could before they had access to an EMR.

Most EMR firms forget that they’re not just a medical database – they are responsible for ensuring that doctors don’t forget to gather important data, that their system can provide alerts to prevent mistakes, and allow data to be used to make better medical decisions in the future. There are a million reasons cited in literature and the press for why doctors don’t use EMRs. I think there are two simple reasons: they’re not useful enough to invest their time yet and they have no way of being reimbursed for all the extra work of maintaining an electronic record.