Electronic Medical Records

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Electronic Medical Records

An important part of the IPALC mission and vision is to encourage adoption of EMR by physician practices. We wish to draw upon all the resources available in order to help our physicians make good decisions about purchasing and using EMR systems. Our recent survey shows that at least 263, or 22% of the approximately 1200 physicians in our community are using EMR. The national average is about 17%, so it appears that our community is ahead of the curve.

The recently enacted Stimulus legislation provides incentives of up to $44,000 per physician to encourage implementation of electronic health records (see The Stimulus Package and Electronic Health Records). In order to be eligible for the incentive payments, the system in use by the physician practice must meet standards related to meaningful use of a system. The specific details of the standards have yet to be developed and adopted. Some of the systems in use in our community may not meet the standards. These groups will be faced with the decision to either change their system, or lose the opportunity to receive this incentive. We want all physicians to be aware of these standards and other issues that will be essential to making decisions about selection of an EMR system.

The allure of all this money is creating something akin to a feeding frenzy among EMR vendors. They are marketing aggressively to get a piece of the pie. Unfortunately, it remains to be seen which products will meet the requirements for the incentive payments. An even more important question is whether these systems will permit physicians to interact and share patient data. This level of functionality seems to be the whole point of the entire effort.

LMHS has chosen Epic ( www.epicsystems.com) as the EMR system for the LPG physician practices. This system has also been implemented in the hospital Emergency Departments. With funding from the stimulus legislation, they are moving forward with implementing Epic as the electronic record system for inpatient care at all the hospitals. The projected date for this implementation is 2011. All the data currently accessible via NetAccess has already been imported into Epic. The vision is to create a record which seamlessly integrates all inpatient and outpatient data. This is an incredibly powerful concept which has the potential to make it simple to access virtually all the clinical data for patients from anywhere in the system. It remains to be seen whether other EMR systems will be able to interface with Epic.

There are alternatives to an integrated EMR system. The first is Clinical Groupware, a concept that is being developed. The next is the idea of personal health records, a concept that has already become available through Google Health and Microsoft HealthVault. This gives patients control over their own records, although there are privacy concerns as these systems are not subject to HIPAA regulations. The other concern is that these systems require the patient to manually enter data.

Interoperability of EMR systems is a goal that has been discussed at great length, but has yet to be achieved. The Continuity of Care Record is a set of standards that have been created to allow an EMR system to export a patient record in xml format. This record can then be directly imported into another EMR system. It sounds like a great concept at least in theory. At this point, this standard has not yet been implemented.

So, where do we go and what do we do? We do not have all the answers, but we will continue to try to find them...

Journal Articles:

Stimulating the Adoption of Health Information Technology (NEJM 4-9-2009)

Use of Electronic Health Records in US Hospitals (NEJM 3-25-2009).pdf

Stimulating the Adoption of Health Information Technology (NEJM 4-9-2009)

Your Doctor’s Office or the Internet? Two Paths to Personal Health Records (NEJM 3-26-2009)

No Small Change for the Health Information Economy (NEJM 3-26-2009)

Ownership of Medical Information (JAMA 3-25-2009)

Health Care Information Technology Vendors' "Hold Harmless" Clause (JAMA 3-25-2009)

Use of Electronic Health Records in U.S. Hospitals (NEJM 3-25-2009)

Electronic Records in Ambulatory Care--A National Survey of Physicians (NEJM 6-18-2008)

Electronic Health Records Medical Research and the Tower of Babel (NEJM 4-17-2008)