The EMR has several advantages over the paper charts that it replaced. It is legible, cannot be misplaced and it eliminated paper prescriptions and paper orders. However, the current iterations have several disadvantages.
- The information density is very low in that a physician trying to understand the clinical course of the patient finds it difficult to access the relevant facts. It is laced with legal documents, consent forms, appointment verifications and other administrative information.
- The physician has become a data entry clerk. In addition to doctoring the patient he/she has to doctor the chart. It contributes to physician burnout and raises the cost of medical care.
- The information quality is poor in that physicians are poor data entry clerks and much of the physician’s notes are copied and pasted to save time and are thus inaccurate.
- As each provider be it doctor, hospital or imaging center has its own EMR, the patient’s medical record is scattered about. A physician trying to care for the patient almost never has full information. Much time and effort is necessary to acquire information from the various sources. This also increases the cost of care.
- The EMR is expensive with monthly fees paid by providers.
- The patient has no access to his records.
Why is this? It surely is not a technical problem. We can understand the problems better when we realize that the main purpose of the EMR is to facilitate billing. The rule is “If you did not document it, you didn’t do it.” and thus you will not be paid. We need an EMR that is patient centered and not connected to billing at all. Such an EMR will not work with the current insurance system.
An employee owned healthcare cooperative can correct most of the problems of the current EMR. If the cooperative maintained the EMR, all patient records would be in one place. The various providers could access and add to the EMR with no cost to the provider. Patients could have access. The information could be arranged with ease of access by providers the primary goal. With modern technology, the office visit could be recorded including the Chief complaint (reason for the visit) and the history. The physician could orally record the pertinent positive and negative physical findings and the conclusions. The recorded discussion with the patient about further testing and procedures would complete the visit. A data entry clerk working for the cooperative can then enter the diagnoses on a diagnosis list and record new medications on a medication list; Vital signs can be entered by the doctor’s office as well as by patients. Sections for lab and imaging would be maintained by clerks. No longer would doctors be adding data; they would be free to spend more time with patients. The copy and paste repetition of data would not clog the record. Administrative data would not be part of the EMR and could be stored independently by each provider.