Issues in Electronic Medical Records

Electronic medical records (EMR) promise to transform health care by improving safety and efficiency. The stacks of paper that record patients' health status have always clogged doctors' offices and other health facilities, slowing the delivery of diagnoses and care and compromising patient safety. But the elimination of these paper records is no easy task. While EMRs are intended to improve health management and disease prevention, implementation presents myriad challenges ranging from technological hurdles to cost.


The potential cost benefits of EMR adoption for outpatient and inpatient care are estimated to be more than $77 billion a year if 90 percent of health care providers used EMR systems, according to scientists at RAND, a non-profit think tank that analyzes public policy. Those savings are likely to come from shorter hospital stays, reduced usage of nurse time for administrative tasks such as searching for paper records, reduced testing and re-testing and reduced drug use.

The potential patient safety benefits include reduced drug errors with use of computerized prescription order entry (CPOE), a type of software often used with EMRs to automate the prescription drug process. Medication errors have been studied for years and account for about 8 million outpatient errors a year. About one-third of those could be prevented with EMR/CPOE systems, according to the RAND scientists in a report on how EMRs could transform health care.

Another huge potential benefit from EMR adoption is related to the management of patients who have chronic diseases. Fifteen chronic diseases or conditions account for more than half of all growth in health care spending in recent years, RAND researchers reported. EMRs could be used to better manage patients with chronic conditions, tracking their health status, medication usage and lifestyle interventions so that health care providers can step in before a costly crises occur.


The cost of EMR systems has been a barrier for many physicians and health care facilities. In addition to the price of the software and hardware, there are costs associated with the transition from paper to electronic records, costs of training personnel and the cost of technological upkeep.

A study by the Michigan State University (MSU) EMR Medical Director found that EMR implementation can costs between $21,750 to $152,000 per physician depending on the system chosen. Thereafter, annual costs can run from $9,250 to $12,791 per year to maintain. Calculating savings is much more complex and controversial because a variety of health care office tasks are changed from reduced need to transcribe records to the cost of staff to pull paper records. It's even more difficult to factor in the savings from avoided errors that occur with paper medical records. The MSU director's report estimated hard dollar savings ranging from $251,900 in a doctor's office setting to $356,395 for a clinic setting.

Technological Challenges

One of the biggest issues in EMR adoption is the fact that a variety of systems exist, but they aren't all necessarily compatible with each other. So if a patient visits a doctor with one system, then enters a hospital that has another system, that EMR may not transfer easily. David Brailer, national health information technology coordinator in the U.S. Department of Health and Human Service, points out that interoperability---the ability of one system to speak with another---is vital for the successful exchange of health care information. The need for data integration also extends beyond EMR systems to other health information technologies such as patient monitoring equipment. Without interoperability, the health information system will remain fragmented.


Another major issue continues to rise to the surface when it comes to EMRs: the potential for privacy breaches. While most doctors favor the use of EMRs, they have expressed concerns about patient privacy, as detailed in two articles published in the "Journal of the American Informatics Association" (JAMIA). In one report, 16 percent of 1,000 physicians interviewed said they were very concerned about privacy breaches and 55 percent were somewhat concerned. A second study surveyed psychiatrists, psychologists, nurses and therapists. Of those who responded, 63 percent said they were less willing to record information considered highly confidential in an EMR compared with an paper record, particularly due to the fact that it was psychiatric information about patients. In general, doctors want to participate, but they also remain concerned for patients' privacy, suggesting that technology developers need to beef up EMR security functions.