Electronic Medical Records: The Good, The Bad and The Ugly

Electronic Medical Records are here to stay. Regulations propounded by Medicare and Medicaid are phasing in the requirement that all health care professionals, including hospitals, maintain all medical records in electronic format. There are obvious benefits to having universal medical records. Accurate medical histories are one of the most important tools doctors have in diagnosing and treating illness. Unfortunately, many of us do not remember the details of a lifetime of medical treatment. We move from city to city; we change doctors frequently, especially when our health insurance changes; some of us have been hospitalized, often in more than one hospital. The ability of a doctor to quickly access all of a patient’s medical records can be an invaluable item in his or her tool box. Also, no one will ever again have to figure out what a doctor’s chicken scrawl was supposed to say.

How this theoretical benefit works out in practice remains to be seen after the electronic medical record (EMR) requirement is fully implemented in 2015. First, there is the question of privacy. HIPAA, The Health Insurance Portability and Accountability Act of 1996, and the regulations issued by the Department of Health and Human Services require that every medical provider keep the patients’ charts confidential. That’s why every time we see a new doctor we are required to sign a statement acknowledging that we understand the confidentiality rules. While the old fashioned papers records have to be photocopied, it’s a lot easier to send an attachment to an email. We suspect that maintaining confidentiality will be that much harder when everyone’s records are stored electronically.

From our perspective as attorneys working in the medical malpractice field, aside from the legibility question, electronic records are just a pain in the neck and, I suspect, are hard for our health care providers to use as well. Let me give you an example: The typical paper hospital record is divided into logical sections such as progress notes (the notes the doctors write every time one of them sees the patient), nurses notes, orders, test results, etc. The handwritten notes might be hard to read, but there is no problem finding them in the chart.

Not so with EMRs. First, you have to figure out exactly how the records are kept. More likely than not, they are in chronological order, so doctor’s orders could be all over the place. Many times the same information is seen over and over again, which makes the records much longer than need be.

It would be difficult enough if there was a single, standard way in which EMRs are maintained. Unfortunately, that is not the case. Conversion to electronic medical records is big business. There are many vendors competing for a piece of the pie, and each has its own system. In fact, some hospitals right now use multiple systems for different parts of the hospital. At some point standardization will be required in order to achieve a truly portable and useful system.

Someday EMRs will really achieve their primary goal of improving health care. When that actually happens remains to be seen.