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Vol. 66, No. 4 2015
Northeast Florida Medicine
DCMS online
. org
From the Editor’s Desk
Sunil Joshi, MD
Editor-in-Chief
Northeast Florida Medicine
Nowadays almost everything can be done online from
purchasing a television, an airline ticket or clothing to
earning a master’s degree without ever stepping onto a
college campus. In
the last 10 years, this
transition has been
swift and universally
accepted.
Despite this, approx-
imately 40 percent of
physicians continue to
practice without elec-
tronicmedical records.
In an age when people
can shop for grocer-
ies from their phone,
millions still receive
written medication
prescriptions and have no way of communicating with
their physician without picking up the phone. The reasons
for not implementing some form of EMR range from the
cost of the system to concerns over the implementation
process and the amount of time necessary to research
the proper system. These, of course, are legitimate issues
but, in the end, the benefits will hopefully outweigh the
initial drawbacks.
Benefits of EMR:
The obvious and most basic benefits associated with
electronic medical records include the elimination of
poor penmanship and the ease of chart access. Whereas
the office staff may spend a considerable amount of time
searching for paper charts, this is never a concern with an
electronic system. Instead of writing a prescription in a
hurry between patients, recording it in the chart, handing
it to the patient who will then take it to the pharmacy for
it to be dispensed, with a functional electronic system a
prescription is sent to the pharmacy with one mouse click
and with drug-to-drug interactions already checked. It not
only saves the patient time, it appears safer as well. A 2010
Journal of the American Medical Association
study suggests
that there is a medication error rate reduction from 18.2
percent to 8.2 percent one year after implementing com-
puterized electronic prescriptions.
Prior to EMR, a physician’s office would likely have to
track down the results of common blood work because
many times the laboratory would fail to send it in a timely
fashion. With electronic records, typically the lab results
are directly transferred into the patient’s chart and flagged
when results are abnormal.
Vaccines have effectively had a positive impact on health
care for the last 50-75 years. A 2001 study published in the
New England Journal of Medicine suggests that comput-
erized reminders about timely administration of influenza
and pneumococcal vaccinations increased the appropriate
use from practically 0 percent to 50 percent in hospitalized
patients. A similarly designed study published in Arthritis
also demonstrated positive results in the outpatient setting
with an increase in pneumococcal vaccination rates from
19 percent to 41 percent.
Drawbacks of EMR:
There are certainly high costs associated with comput-
erized medical records. A recent estimate suggests initial
costs may be between $19,000 and $50,000 in a practice
of three or fewer physicians. This does not include the cost
of lost productivity during the implementation process.
The initial cost is often followed up with ongoing mainte-
nance for updating software and/or training new users. At
the beginning, an EMR can disrupt work flow which can
result in loss of productivity and increase the non-clinical
responsibilities for the physician. A 2011 study suggests
that during implementation physicians can spend 134
hours learning the system and this increases the non-patient
based cost to over $10,000 per physician.
Moving Forward:
Electronic medical records certainly have positive and
negative qualities both in the short and long-term. However,
over the years, the systems have become more user-friendly
and efficient. Just like every major cog in the United States
economy, the practice of medicine is moving more towards
a computerized electronic forum, without turning back.
Hopefully, over time, we will be able to better quantify
the benefits not just for the healthcare system but also for
the physicians involved.
v
Electronic Medical Records: A Necessary Step