An EMR and a Hammer are Both Just Tools

First and foremost, best wishes to you and your families for happy holidays. Here are a couple of bright spots in the news as we wind up the year.

For anyone worried about potential additional regulatory hassle due to the Red Flags rule developed under the Fair and Accurate Credit Transactions Act of 2003, an exemption for physicians and other small businesses was made when a bill clarifying the term “creditor” was signed into law last weekend. Whether you agree or not, it looks like the federal government does not consider medical records to be a risk with regard to identity theft.

And if you’d like something better than one-dimensional pamphlets or books to explain anatomy to patients, Google has delivered the Body Browser, a free online tool that allows people to explore three-dimensional models in layers. However, because this tool is HTML5-based, you’ll need a browser that supports WebGL. There are basically three browsers from which to choose -- and no, the list doesn’t include Internet Explorer.

However, what I’d really like to write about today is EMRs, because I’ve spent the last several months studying the issues surrounding their much-ballyhooed value, especially when it comes to improving the quality of patient care and cutting down on medical errors.

Amidst the fervor of getting EMR implemented in medical offices across the country, I think that everyone outside of the medical profession forgets sometimes that you can’t automate medicine. An EMR is ultimately just a tool, and is only as effective as the people who use it. I was a case-in-point last week, and I’ll tell you why.

Let me preface by saying that I feel sorry for any doctor who takes care of me. I have a congenital immune disorder and multiple drug allergies -- penicillin, sulfa drugs, iodine, aspirin, acetaminophen, and ibuprofen are examples of common drugs that either produce hives, a pumpkin-sized head, or a serious drop in platelets.

My mother had to explain this to every physician and medical facility she dragged me to when I was a child, and the need to reiterate medical information hasn’t changed much more than 40 years later. I do the explaining these days, as I did last weekend in the ER after being kicked by a horse.

I verbally gave my history to the intake nurse, who dutifully input the information into the hospital system. I also gave the information to the nurse who initially visited my room to tell me that the attending physician had ordered radiographs and a CT scan.

The technician from radiology wheeled in a machine and took radiographs. Another technician entered the room later and began preparing me for the CT-- with contrast. I asked if there was iodine in the contrast, the technician checked with the pharmacy, and sure enough, there was. The scan was performed without contrast.

At a follow-up visit to a doctor’s office the next day, I was told to take Advil for pain and swelling; when I advised the doctor (who had gotten up from his seat at the computer to speak to me in person) that I was allergic to ibuprofen, he advised me to take -- you guessed it -- Tylenol instead.

I didn’t make a correction, and neither did the technician who had taken his place at the terminal to finish documentation for my visit.

The third doctor I saw, a neurologist who tested me to rule out injury undetected by CT scan, operated off of paper records and took note of my drug allergies.

Again, the hospital staff and physicians I encountered last week were all professional and concerned with my care. However, if I had not been coherent during my stay, medical errors may have occurred and complicated my treatment, even after important information was entered into the system, for no other reason than the physicians and staff didn’t thoroughly read and/or document my history.

This might be identified as an EMR issue, but it may also be a medical business culture issue. The records that were developed at the ER and shared with supporting physicians demonstrated a laser-like focus on finding any potential problem that resulted from an accident. It was the process of dealing with the patient (in this case, me) as a unique individual that fell apart, and that’s something that EMRs just won’t fix.