Electronic medical record (EMR) system*
Disadvantages of paper-based medical record systems
- Paper records have the following significant disadvantages:
- available to only one person at a time
- frequent illegibility
- inability to be accessed remotely or at the time and place needed
- growing so thick as to be unwieldy
- low utility and large overhead as vehicles to evaluate quality
- segmentation with multiple volumes and multiple storage sites
- The most serious problem with paper records is that they impede provision of clinical decision support – data stored in inaccessible formats cannot incorporate or trigger decision support tools.
Advantages of electronic medical record (EMR) systems and some empirical evidence
- In addition to providing complete, legible, easily accessible, and highly organized medical information of all forms (e.g. x-ray and ultra-sound images), electronic systems support clinical decision tools. Such clinical decision tools include: selection of drugs, laboratory tests, and radiographic studies; reminders and prevention guidelines.
- It has been shown that reminders are effective in care of chronic conditions, such as diabetes.
- By providing a tool of selecting the least expensive prescription within a class of drugs, EMR can help reduce drug costs by 18%.
- Several studies showed that displaying charges for tests, the last test result of that type, and predication whether a specific future would be abnormal given prior results reduced laboratory test use by 10-15%.
- EMR allows a covering physician to rapidly obtain a sense of a patient’s problems by quickly reviewing the systematically organized medical information of the patient.
- Computerization of medication prescription improves safety; in one study of in-patients, the medication error rate was reduced by more than 80%.
- Another quality improvement benefit will likely come from monitoring and tracking abnormal results and ensuring that appropriate follow-up occurs.
Electronic medical record (EMR) systems and primary care
- Given the broad scope of primary care, primary care practitioners are required to process a large volume of clinical data.
- However, the unaided human mind simply cannot process the amount of clinical data required. Thus, physicians take “short cuts”, using clinical experience and heuristics rather than pursuing organized investigations.
- EMR systems with various clinical decision support tools can help in this regard.
- Studies showed that primary care physicians could pursue only 30% of the required clinical questions when seeing their patients. Many of the information needs of primary care physicians for optimal clinical decision are not met.
- EMR with well organized medical history of a patient can help primary care physicians decide the most important clinical questions to ask.
- EMR can facilitate the referral process. It also reduces adverse drug events and unnecessary tests and treatments across different levels of care.
Foreign experience of implementing EMR systems in primary care
- Both Australia and England have implemented highly successful national programs to promote the use of EMR systems in primary care. New Zealand and the Netherlands have also achieved substantial success.
- In terms of speed, Australia’s results have been most dramatic. In May 2000, 70% of general practices stated that the majority of physicians in their practices were using computer in their consulting room to generate most of their prescriptions, compared with only 15% of general practitioners reporting computer use for any purpose in October 1997. Australia achieved this remarkable transition by providing practitioners with financial support to help purchase a computer, supporting system implementation for those who needed it, and offering incentives for providers to submit claims electronically.
- In England, in 2001, 98% of general practitioners had access to EMR on their desktop. Nearly all used it for prescription refills, and 30% reported that their practices were paperless.
- All 4 countries mentioned above made a national investment in a coordinating group to develop a strategic framework and identify standards. Development of the actual records has been carried out by private vendors, who have benefited from having a common set of goals and standards. In addition, each country developed incentives for providers to make the transition from paper to electronic records.
Barriers to adopting EMR systems
- High initial set-up costs.
- Transience of vendors and compatibility of data formats. The barrier can be solved by adopting common data standards.
- Physician resistance to use of EMR systems.
- Concern about security and confidentiality of electronic information.
Prepared by Winston Ng (吳君韻)
Healthcare Policy Forum (醫療政策論壇)/Hong Kong Democratic Foundation (香港民主促進會)
6 May 2006
*The purpose of this document is to provide a short introduction to the subject matter for discussion. The contents of this document are quoted directly or paraphrased from the original source listed in the Reference. Please do not directly quote for publication use.
Bates, David W. et al. 2003. A proposal for electronic medical records in U.S. primary care. Journal of the American Medical Informatics Association 10(1): 1-10.