Mandatory Electronic Medical Records

Electronic medical records hold great promise for improving quality of care. Development of a national electronic health records system, however, is progressing slowly. Today, less than ten percent of physician practices use an electronic medical record. It surprises me that some health care professionals still question the benefit of moving from paper to computerized records. It's time all health care providers large and small embrace and invest in medical records technology for the benefit of their patients.

Since 1992, care for all patients in the UNC Health Care System has been managed with the use of a detailed electronic medical record. These private, individual records integrate patient care information in both hospital and clinical settings, and encompass extensive patient histories, drug treatments and protocols for effective disease management. Each day, more than 3,000 care providers access this system and look up over 56,000 patient records. The system holds the medical record for almost one million outpatient and inpatient visits annually.

We invest significant resources in our records system every year, adding more capabilities that improve the efficiency of care delivery and minimizing the possibility of errors that occur due to a lack of information or just not having a total picture about the health history of our patients. There is no doubt in my mind that electronic medical records are as important for our patients as any other new medical technology designed to improve the way we diagnose or treat disease.

My friend and fellow National Quality Forum board member David Brailer is the National Health Information Technology Coordinator at the Department of Health and Human Services. The President has charged his office with developing an industry and federal government-wide strategy for widespread adoption of health information technology, and translating this into substantial quality and efficiency improvements within a decade ( Congress has appropriated millions of dollars to help this office achieve its charge. Several provider organizations across the country are beneficiaries of these resources. This is an outstanding program that will help identify and define the best paths forward for electronic records technology.

The government must do more to accelerate the pace of change concerning adoption of medical record technology at the provider level. It is time these systems became a mandatory part of medical care and government should make it clear that all providers will participate in this movement.

I know from experience that if the government sets a deadline for reasonable actions, the industry responds accordingly. When I was at HCFA in 1980s, we decided that all hospitals caring for Medicare patients should start reporting their mortality rates. No doubt, there was resistance. But the hospitals cooperated and we learned tremendous lessons from the data collected.

I recently encouraged the leadership at CMS to consider requiring, as a condition of participation in the Medicare program, all hospitals and physicians to convert to electronic medical records by some reasonable date perhaps December 31, 2008. This approach leverages the power of the nation's largest insurance program as an incentive to comply. It would also motivate the industry to more quickly develop standards addressing the questions and uncertainties that still exist about widespread adoption of electronic records.

When the dust settles, our patients will be better off. And that's why accelerating the pace of change is well worth the effort.

3 thoughts on “Mandatory Electronic Medical Records

  1. joseph lee

    You are absolutely correct regarding the need for electronic medical record. Based on the experience we and others have in introducing Picture Archiving Communication System (PACS) in the last decade, one of the challenges is to change culture and work flow behavior. In the case of radiologic images, naysayers gave zillions of reasons why hard copy images are better than soft copy ones and resist changes. However, once it is introduced and implemented, no one will ever want to go back to the old system with hard copy images!


  2. mitchell wilson, md, physician advisor UNC hospitals, medical director, department of clinical care management

    It surprises me that some health care professionals here at UNC still document inpatient progress notes, inpatient consultations and other clinically relevant inpatient information in the paper chart! Dr Runge, Chair of Medicine, and Dr Greganti, Vice-Chair, have catalyzed the conversion to electronic documentation in WebCIS for all of the Department of Medicine–and the medicine docs have done a terrific job in complying with this mandate. It's time all inpatient health care providers at UNC hospitals embrace documentation in WebCIS for the benefit of all of our patients.

  3. Dr Raj Gopalan

    This is a wonderful article. We are very proud to have an EMR that is extensively used by our care providers. It has millions of patient records. Thus we have tons of data (raw materials), and hence ideally positioned to mine those vast amount data to uncover very crucial knowledge. This would help us to understand how we do our business, what areas we excel, what areas needs attention. This also would help us to drive P4P (3rd article). Hence, I recommend to pursue our efforts in building a data warehouse, that would help us immensely, in improving clinical decisions, outcomes, utilization, cost containment, education and research.


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