Thursday, July 21, 2005

EMRs are coming, EMRs are coming

Here is my response to an article by Ken Karpay in the periodical, Physicians Practice (July/August): The article's thrust is fairly obvious from the title: that electronic medical records are on the way, in a big way, whether physicians resist or not, but with potentially great benefits to us, blah, blah, blah...


EHRs are coming – Like it or Not

Dear Ken,

I recently read your ‘Politics and Your Practice’ column for July/August of Physicians Practice. I too believe we have reached a ‘tipping point’ in the migration toward EMR in medical practice; politics surely has proved to be the critical force in the impending turning point. In general, I agree with the main thrust of your article. As a physician and medical informatician in Rochester, New York who has both developed and used EMR technology in an Internal Medicine practice I can attest to both the pitfalls and benefits in this space.

I would expound on one point you made in the article: “…you will have something you’ve never had before: hard data about your practice.” Control of one’s data is the critical point here. Many central entities around the nation (Regional Health Information Organizations, or RHIOs, for example) are forming in an effort to entice/push (depending on your perspective) physicians toward EMR adoption. These efforts often entail centralizing data (e.g. lab data) in a community; in some areas of the nation the efforts are quit evolved—e.g. offering an ASP (application service provider) model to deliver EMR technology from a central source. The central stores of data in these initiatives will have the potential to NOT be in the control of individual practitioners. This potentially could serve as yet another means to micro-manage physicians’ practices. And if you think current “report cards” often produced by IPAs today are detailed just wait until the highly granular data from an EMR makes it to a centralized data repository. Third parties will have unprecedented access to very detailed information regarding practice operations.

I implore physicians and other providers to educate themselves about health information technologies. We all must ensure that we have first access to the data we collect; that we retain a high degree of control over these data. The risk is that we become glorified data entry personnel for third parties (to a greater extent than we already are) and hence, actually diminish our already slipping grip on practicing medicine. I am a big advocate of information technology. However, if physicians approach EMR adoption passively (or passively aggressively) they risk getting run over by this horse that is clearly out of the barn.

Egan F. Allen, MD

Internist and Health Information Technology consultant

Pittsford, New York

1 comment:

Anonymous said...

"Hard data" is an interesting term. It suggests something far beyond what we see now. But the real hard data is simply a disease code or two (or three or four, I am an internist) plus a CPT code. The rest of my notes is one big long text file.
Currently, this provides no additional hard data in the usual field format for DP ("IT"?) work. So my text file is little more than a typed note.
I do see a patient who is working with a startup company which does "natural language searches" for diagnosis codes. That may be very interesting one of these days.
I have been typing my office notes for 2.5 years, since the fire on the roof ran us out of the building. I had a CD backup the night before, so I wasn't too worried about records loss.