Electronic medical records — still a long way to go

Working as a physician in a hospital means being buried with paper — lots of it. A patient’s medical record, the medical chart, is typically a fat three-ring binder that gets rapidly fatter by the day the longer the patient stays in the hospital. Children in the PICU may build up a medical record that weighs more than they do. Old medical records for patients — records that describe their previous hospital stays — are often delivered to the hospital floor from the medical records department in a very full shopping cart. Plowing through these old records can take hours. More importantly, one can miss important things, key nuggets buried deep in the largely unhelpful mass of paper. And, of course, if the patient has had medical experiences at another hospital, those are not even in the chart.

Many believe the answer is an electronic medical record (EMR), with everything stored on a computer. The record can be easily organized and searched for important information. Assuming that systems are standardized (a big if), the record can then be easily portable and travel with the patient on a disk or be sent over the internet.

The whole topic of EMR is a highly emotional one among physicians. Many like the idea, many absolutely hate it, even though the latter group recognizes the EMR is inevitable, really. For hospitals, the start-up costs of implementing the EMR can be huge. Thus far, few have done so. A recent survey in the New England Journal of Medicine found that only 1.5% had done so in a comprehensive way, although many had begun implementation of various portions of the EMR. The Obama administration has proposed federal funds for part of the costs, but inevitably each hospital will have to spend money upfront to initiate EMR systems.

For myself, I happen to work at one of the few hospitals with complete EMR. I like it a lot. For PICU practice, the ability to get important data quickly is key to giving good care to critically ill children. I’ve been doing this for 30 years, long before there were computers on every (or any) desk and the EMR allows me to do my job better. I look forward to seeing it implemented across the nation.