Nurses: Tell Us about Electronic Medical RecordsThe Good, the Bad, and the Ugly

EMRs would make healthcare better, safer, and more efficient but if every person's
complete medical history was stored on computers linked up across the country.
Clinicians anywhere could view a patient's every blood test, hospital stay, and X-ray;
smart software would guide diagnoses. In hospitals, prescribed drugs and doses would
be computer-vetted against each patient to forestall life-threatening medication errors.
The medical community's general reaction: great idea, but difficult and expensive. As
the years passed, hospitals did gradually adopt "computerized physician order entry" for
prescriptions, but otherwise marriages between computers and healthcare largely took
place in billing departments and other back offices.
That is now changingquickly. Hospitals have come to appreciate the value of
collecting and analyzing data that help them understand where and how often things go
wrong, sometimes dangerously but more often wastefully. And the federal government,
aided by provisions in the health reform law, is waving a financial stick in one hand and
dangling a carrot in the other to punish or reward doctors and hospitals that variously
resist or embrace health information technology. The Department of Health and Human
Services is offering financial incentives to hospitals and doctors' practices that can
achieve what it calls "meaningful use" of electronic records by certain dates. Providers
who fall behind in achieving meaningful use will eventually receive lower reimbursement
rates for treating Medicare patients.
At last, the connectedness era is approaching. It's still not easy, and it's still costly.
Entering test results, creating a progress timeline for a patient, and throwing away the
prescription pad are newly required skills, and burdens in the short run, for harried
doctors who may have neither the money to afford the new technology nor the time to
learn how to use it. And while some healthcare professionals swear that EMRs help
them provide better care, evidence to support that idea is limited.
A study published last year in the American Journal of Managed Care found that EMRs
can lead to a higher quality of careif they include interactive features, like software
that skims records looking for gaps in care, such as an overdue mammogram, and Emails reminders to patients. Among Kaiser Permanente patients such a system was
tested on, the tool bumped up the number of diabetes and heart disease patients who
came for regular health screenings, vaccinations, and medication adjustments; after
three years, the percentage of patients receiving recommended care each month
jumped from 68 percent to 73 percent.
The case for electronic medical records is compelling; they can make health care more
efficient and less expensive, and improve the quality of care by making patients medical

history easily accessible to all who treat them. But as health care providers adopt
electronic records, the challenges have proved daunting, with a potential for mix-ups
and confusion that can be frustrating, costly and even dangerous.
Doctors told county supervisors they were able to see only half as many patients as
usual as they struggled with the unfamiliar screens and clicks. Nurses had similar
concerns. At the county jail, they said, a mistaken order for a high dose of a dangerous
heart medicine was caught just in time.
Like all computerized systems, electronic records are vulnerable to crashes. Parts of the
system at the University of Pittsburgh Medical Center were down recently for six hours
over two days; the hospital had an alternate database that kept patients histories
available until the problem was fixed.
Even the internationally respected Mayo Clinic, which treats more than a million patients
a year, has serious unresolved problems after working for years to get its three major
electronic records systems to talk to one another. Dr. Dawn S. Milliner, the chief medical
informatics officer at Mayo, said her people were working actively on a number of
fronts to make the systems interoperable but acknowledged, We have not solved
that yet.
Still, Dr. Milliner added that even though there a lot of challenges, the benefits of
information technology are enormous improved safety and quality of care,
convenience for patients and better outcomes in general.
Patients at Mayos headquarters in Rochester, Minn., and its Arizona and Florida sites
can see their records online, even via an iPhone app; those in Mayos network of
doctors offices and hospitals in the upper Midwest will eventually have similar access.
In the rare event that a large-scale system goes down at Mayo, backup measures are
ready, teams are called in to make rapid repairs, and if necessary everyone is ready to
go on paper, Dr. Milliner said.
Based on error rates in other industries, the report estimates that if and when electronic
health records are fully adopted, they could be linked to at least 60,000 adverse events
a year.
Deborah Burger, a registered nurse for more than 30 years who works with pain
medicines and anti-anxiety drugs for colonoscopy patients, said electronic systems
offered drop-down menus of so-called best practices.
The problem is each patient is an individual, said Ms. Burger, who is president of the
California Nurses Association. We need the ability to change that care plan, based on
age and sex and other factors.

She acknowledged that the system had one advantage: overcoming the ancient
problem of bad handwriting. It makes it easier for me to read progress notes that
physicians have written, and vice versa, she said.
To answer this question, lets start by saying that, depending on how the data is used, it
can be either. So the question is, to what extent can we garner the benefits of an
electronic health record (EHR) while maintaining data privacy? Most of us are aware
that the risk to privacy of any information increases exponentially with each additional
person whom we tell. This is especially true for electronic communication. Social
networking members, who have shared what they thought was private information with
friends, have too often found that the information is now accessible far beyond what
they ever imagined; now it is permanently engraved in cyberworld. These observations
rightly raise concerns when information in a medical record is involved.
People are asking whether any kind of electronic records can be made safe. If one is
looking for a 100% privacy guarantee, the answer is no. But then, paper records are not
100% secure either. There have been cases where paper medical records, especially
parts of them, have disappeared. There was a case where boxes of patient records
from a doctors office were found in a garbage dumpster (Preventing Medical Identity
Theft, 2008) and a case in which stolen medical records were recently found washed up
on a Maine shore (Associated Press, 2008b). Additionally, disposing of paper records
can be a privacy breach as a teacher in Salt Lake City, who had purchased medical
records from 28 Florida hospitals to use as scrap paper for her students, learned
(Associated Press, 2008a).

References:
1. (2011).The Era of Electronic Medical Records: EMRs may be finally coming to a
hospital or doctor near you. Retrieved from: http://health.usnews.com/healthnews/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals?page=2
2. Freudenheim, M. (2012). The Ups and Downs of Electronic Medical Records. New
York. Retrieved from: http://www.nytimes.com/2012/10/09/health/the-ups-and-downs-ofelectronic-medical-records-the-digital-doctor.html?pagewanted=all&_r=0
3. Thede, L., (March 30, 2010) "Informatics: Electronic Health Records: A Boon or
Privacy Nightmare?" OJIN: The Online Journal of Issues in Nursing Vol. 15 No. 2.
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