The Eternal Promise of the Electronic Health Record
Almost every store I go into takes my Visa card. Every CVS drug store has a record of all of my prescriptions and I can refill them at a moment’s notice.
So I would think that my medical information would be available to every doctor from whom and in every hospital from which I receive care.
But I would be wrong.
A study released last month in the New England Journal of Medicine found that fewer than one in five physicians are using electronic health records (EHRs). The main reason that doctors gave for not implementing them was the lack of financial incentives for making the investments of both time and money. Some of the costs for failing to adopt EHRs include increased opportunities for medical errors, poor coordination of care information between providers and duplicative administrative burdens. But many physicians believe that most of the benefits accrue to insurers or patients and that they are burdened with not only the financial investment of equipment and staff training, but also the cost of conversion from paper to computer records and the loss of valuable time with patients during the transition.
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Jessie
Gruman
President
Center for the
Advancement of Health |
A transportable electronic health record in every doctor’s office and hospital has been promised as “right around the corner” since the early 90s. The lack of progress is discouraging and both the costs of the failure and the frustration of physicians and health administrators receive considerable media play.
What receives far less attention is that many of the administrative tasks that EHRs eventually will perform now fall by default to patients. If we are to be certain that our doctor has all our health information, we have to keep a cumulative medical record at home. We are responsible for gathering and organizing all test results and records of vaccinations, diagnoses, visits, prescriptions and devices. Then we must organize this information in a format that is easy for a doctor or nurse to read quickly and we must select the relevant portions to bring to each physician visit. Doing this may not be a burden for some healthy people, but for those with complicated medical histories, more than one disease or condition or an aging parent on the other side of the country, these administrative responsibilities require a considerable knowledge and commitment.
Google, Microsoft and countless other commercial vendors have released electronic personal health records that they say are designed to solve these problems. As long as my physicians can’t or won’t accept my version of my health record, however, they simply represent an exercise in typing.
Few efforts have been made to explain to us why we must take charge of organizing and communicating our own personal medical information to our various providers and how to do this effectively. Indeed, our attempts to coordinate health information, which require considerable sophistication and judgment, are often met with little cooperation and sometimes resistance.
Every newspaper article and professional presentation of EHRs includes a long list of the problems they will solve and the risks incurred by not solving them. In the meantime while we are waiting for the interests of commercial and professional stakeholders to align, we patients are the ones who, with little meaningful direction and support, are solving many of them—or not—as best we can.
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