Defininition of Electronic Medical Records

A medical record is a history of a patient's medical visits. An electronic medical record (EMR) is a digital capture of that same type of information, whether it's at a physician's office or any other medical facility.

History

• Back in the 1960s, Dr. Lawrence Weed proposed a type of electronic medical record system that he called a problem-oriented medical record. His idea was to integrate the medical information of patients from different physicians to be able to provide better health care. Based on his idea, the first EMR system started in 1970 at the University of Vermont. Its system was simple, as it used touch-screen technology available at the time to chart procedures and the different types of pharmaceuticals used during those procedures. It was also limited because there was no way to capture the free-form style of written medical records.

Other Early EMR Types

• Although Dr. Weed's early efforts were geared toward the sharing of patient information, it was a costly prospect. Other hospitals did go this route, but the majority of hospitals went toward trying to find ways to reduce the amount of paper caused by having to hold onto medical records for so long. This resulted in hospitals trying things such as microfiche, microfilm and optical disks. This helped with storage, but didn't work as far as sharing information with other hospitals or physicians, especially in real time.

  Even during this time, there were some systems that had EMR capability. However, those systems weren't universal to the entire hospital. EMR systems were developed for specific departments such as radiology, laboratory and pharmacy departments; they lacked the ability to share with anyone else. Moreover, computer systems from different vendors wouldn't fully integrate with each other, and most of the time hospitals would have different systems for each of their departments.

Benefits

• There are some benefits of EMRs. Being able to immediately connect to a patient's information anywhere around the world in an emergency would ensure medical mistakes aren't made, such as giving a patient the wrong kind of medication. EMRs would last longer than paper and save space when it comes to storing records, since medical records are supposed to be kept for a certain number of years depending on the state. They would also be better protected from dangers such as fires and floods, and would be easily backed up in electronic form.

Risks

• The risks are many for EMRs also. There is no one standard for encryption, which means not all health information is protected to the same degree. As more outsourcing has been occurring--sending information out of the country--these countries don't have the same rules for privacy that the United States has, and there have already been health systems that have been threatened with the release of patient information on the Internet if they're not paid. Also, it's harder to trace changes to an EMR, which could result in fraud or entities trying to hide medical mistakes.

Issues

• Technology has come to the point where EMR is a legitimate way to share medical information for all entities. Yet, even now, it's in limited use in the United States. The "New England Journal of Medicine," in April 2009, released a report saying that only 1.5 percent of hospitals have a comprehensive EMR system, with 7.6 percent having a basic system. Surveys of physicians come back with a range of 10 to 25 percent of physicians having some kind of medical records system.

  The biggest issues are cost and integration of systems. Both physicians and hospitals are reluctant or unable to shoulder the costs on their own, and only now has there been attempts for systems developed by different vendors to integrate with hospital mainframe systems in some fashion. Also, only now have some insurance companies been able to receive EMFs, including Medicare. But with the passing of the American Recovery and Reinvestment Act of 2009, which brings $20 billion to a program to encourage both hospitals and physicians to go the electronic route, and the provision of reduced reimbursements from Medicare for those who don't have an EMR program by 2012, EMR will be coming whether everyone is ready for it or not.