EMR - Promises Made, Promises Broken

 Over the past 15 years or so, I have endured several electronic medical record (EMR) systems. Indeed, there is an entire category, EMR Quality, on this blog where I share with readers the good, the bad and the ugly in the EMR space.  If you are suffering from insomnia, I invite you to review these posts nightly.

When EMR was creeping onto the medical landscape, physician grunts like me were salivating over the prospect that one of our thorniest and frustrating challenges was about to be solved.  EMR promised that all of our patients’ records could be accessed with a couple of keystrokes in our own offices.  This made sense as we all knew that the digital world could create linkages that would permit access to all of a patient’s medical experiences.  Regrettably, this promise that was made to medical professionals and the public remains unfulfilled.

Here’s why physicians were so ripe for the EMR seduction.  Consider this typical scenario in the pre-EMR era.

A patient comes to my office with stomach pain.  She was seen for this complaint at 2 local emergency rooms (ER) which fully evaluated the patient with laboratory studies, CAT scans, an EKG and history and physical examinations  (It is likely that the 2^nd emergency room repeated everything that was done in the 1^st emergency room as they might not have known of the initial ER visit or they had difficulty obtaining the records, especially if the 2^nd visit occurred at night.)  The patient then followed up with her primary care physician (PCP) who repeated labs that he told her were abnormal in the emergency room.

Seeing patients without records was like wearing a blindfold.

When I see such a patient today, I may have none of the above records when the patient is before me.  Do readers think that these records might be helpful  to properly advise the patient?   If the patient tells me that the CAT scan results were normal, do I rely upon this without viewing the actual reports?  When she tells me that the first ER physician sent her home with some kind of antibiotic, which the 2^nd ER physician told her wasn’t necessary, might I need to know more about this?  

Every physician over a certain age can recall thousands of similar scenarios.  In my hypothetical vignette above, in the olden days we would send both ER’s and the PCP signed authorizations to forward the medical records to my office.  It might take weeks to hear back.  Or we might not hear back at all.  Or we might get only a portion of the requested records.  Or, we might get records we didn’t request at all.  There were instances, for example, when I requested a CAT scan report and a mammogram result arrived weeks later.  

Can you imagine how difficult it is to treat the patient above who had ongoing abdominal pain without the prior records?

Can you imagine how often patients have unnecessary medical testing that had already been done elsewhere but this was not known to the ordering physician?

Can you imagine why medical professionals believed the seduction that EMR was the holy grail for accessing patients’ medical data from near and far?