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Mirage or Panacea?
Jai Chakrabarti, MD
Over the last few years there has been a stampede of activity in the field of health information management. Paper
charts lying in silos of hospitals and doctors’ offices were considered a major barrier to better outcomes. The internet
was transforming society, and medical informatics woefully lagged behind. Many an expert opined that electronic
medical records would solve many of the current problems regarding healthcare quality and value. Healthcare
leaders were certain that the electronic medical record would pave the way to better value.
For every perceived business opportunity in society tool for creating oligopolies rather than stimulating
there is an entrepreneur that fills the need. Enter the competition and creating a level playing field for the
EMR vendors armed with certified products that best providers of health services. There has been
promised the world. Portability, point and click options, recent concern that possible rivalries among EMR
smart billing and more recently predictive analytics vendors may be impeding digital information sharing.
emerged as the hot items to revolutionize medicine. All The New York Times ran a very extensive article
the benefits still seemed to be in the future while the regarding this important issue (1).
costs were very much in the present – the proverbial
mirage of the future theoretical utopia. EMRs are Better as Billing Devices Than
Recording a Medical Encounter
What was forgotten in the heady rush to EMR was the Most of the EMR records that I have come across
simple fact that there was no way doctors could stuff all (and I use one myself at my cardiology practice) have
the meaningful information from a medical encounter not been able to preserve the essence of the medical
efficiently into an EMR. So entered the medical encounter between patient and physician. They look
scribe. Then entered the trained and certified HIPAA like, and indeed are, billing devices that are festooned
compatible medical scribe! So the costs kept on rising with marginally relevant medical information. The
until we realized that all we had done was transform keen sense of focus encapsulated in a thorough medical
paper silos into electronic silos. Meaningful inter- note requires extensive time spent typing into a record
operability of EMR systems was almost nonexistent or speaking into voice activated dictation software. But
since different proprietary EMR brands could not time is a scarce commodity in today’s harried medical
communicate with one another. environment. Hence the doctor whose eyes are focused
on the laptop screen and whose hands frantically
A Lack of Smooth EMR Interoperability - typing while you try to explain your pain. The essence
Why? of a doctor-patient relationship is lost as the traditional
EMR vendors were marketing products that did not medical encounter becomes a digital experience.
easily talk to each other. A recent report to the US
Congress by the Office of the National Coordinator for The pressures of digital documentation have altered
Health Information Technology (ONC) revealed that the very nature of this important relationship.
EMR vendors and big hospital systems were indeed The noted physician and author Abraham
putting up barriers to the sharing of EMRs so that Verghese stated the issue very succinctly,
they could keep patients in their own network (1). In
other words, the EMR has become a powerful business continued on page 6
1.
https://www.nytimes.com/2015/05/27/us/electronic-medical-record-sharing-is-hurt-by-business-rivalries.html
Harm To Patients
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2503702
5.
Saving Patient Ryan - Can Electronic Medical Records Make Patient Care Safer?
http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html
6.
Medicare Bills Rise As Records Turn Electronic – NY Times Sept 21, 2012
http://www.kellogg.northwestern.edu/faculty/b-li/JMP.pdf
7.
Cracking the codes: Do Electronic Medical Records Facilitate Hospital Revenue Enhancement?
By Bin Yang Li (Kellog School of Management)
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1901114
8.
Use of Internist’s Free Time by Ambulatory Care Electronic Medical Record Systems
http://www.npr.org/sections/health-shots/2014/11/07/361148976/electronic-medical-records-built-for-
9.
efficiency-often-backfire
Note
A shorter version of this article was previously published on Dr. Chakrabarti’s LinkedIn page and is available
at https://www.linkedin.com/pulse/mirage-electronic-medical-record-jai-chakrabarti-md/