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The Problem with EMRs in the United States

US medical groups' adoption of EHR (2005)Image via Wikipedia
Dr. Kevin Pho, the medical blogger who writes Kevin, MD, recently wrote an op-ed piece in USA Today about electronic medical records (EMRs). It's worth reading and tackles an important issue. Specifically, Kevin bemoaned the lack of EMRs in many doctors' offices and explored the reasons why more physicians don't invest in EMRs.

The biggest reason? The cost of an EMR can be as high as $36,000 per physician, and the benefits to individual physicians are uncertain. Other potential barriers include a steep learning curve. In the words of Dr. L. Gordon Moore, "When you put an EMR into a primary care practice, your life is hell for the next year." And frankly, the user interfaces of many EMRs are awful. Dr. Jay Parkinson put it this way: "[Many EMRs] look and function like they were designed by freshman engineers on Windows 98."

Practice Fusion, a free, ad-supported, web-based EMR, provides one novel solution to this problem. Previously available only for Windows systems, Practice Fusion recently became entirely browser-based. MedGadget has a review here.

Another potential solution is to have the government provide physicians with an EMR based on the VA's system. (There is a program in place to provide this to physicians, but I don't personally know of any doctors that have taken advantage of it.) While a government-provided EMR has certain disadvantages, here's a description of how the system works in the UK. From the Nephrol mailing list:
For several years all government hospitals in the UK have their own secure
email systems. All government clinical staff have an account on the system
where they work which they can use to send confidential patient information
to other staff within the same institution.

For the last few years we have a secure national email system (NHS.NET)
which can be used to send patient information anywhere within the European
Union. NHS.NET email is encrypted and account holders can only log in from a
PC within the European union (so subject to our data protection laws which
have been standardized within the European Union). The email message is
encrypted on the user's PC and only decrypted on receipt by the recipient's
PC. Any person employed in a clinical capacity by the UK national health
service (NHS) can have an account on NHS.NET.

Renal patients in the UK also can access their electronic patient records
over the internet using http://renalpatientview.org .

Data is sent (encrypted) from the hospital renal electronic records into
RenalPatientView each night. Patients can see their up-to-date lab results,
drug lists clinical records etc. using a web browser. The web site has some
patient information specific to their diagnoses also.

In my clinics, I ask the patient to look up their results the next day, then
discuss them with me by email. I tell the patient what to look for (e.g.
rise in creatinine).

I can access the patient records over the internet from home or while
travelling and can communicate with the patient and clinical colleagues by
email if required.

General practitioners may also access the patients renal records over the
internet (with the patient's permission). This is useful as we co-operate in
the patient care and the general practitioner need to know the results of
our clinical consultations, up to date drug lists etc.
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About the Author


Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.