Digital Doctoring: Your Electronic Health Record, A Blessing Or A Curse?

The digital age is here (who hasn’t noticed)! In many of the simple items you purchase there is a small chip. Every business and nearly every household uses a computer to improve efficiency, get more important information easily and quickly, and reduce costs. However, physicians are the last segment of our American society to be adequately computerized.

Nearly all hospitals across the United States have Electronic Health Records or EHR (also called Electronic Medical Records or EMR). Electronic Health Records in hospitals make it possible for you to obtain important medical information such as your pathology reports, x-ray reports, laboratory reports, consultations by physicians, history and physical by your admitting doctor, and a hospital discharge summary completed by the physician after you have been discharged. At the time you are about to leave the hospital, be sure to ask for all of these from your nurse or receptionist at the nursing station.

But in the physician’s office, only 17% of doctors have Electronic Health Records. According to a recent article by Dr. Catherine DesRoches of Harvard Medical School and her colleagues (New England Journal of Medicine, volume 359, page 50, 2008), only 13% of all doctors had a basic electronic system, and remarkably, only 4% had a fully functional system that allowed for ordering laboratory tests and X-rays, sending prescriptions electronically, warning of drug interactions or out-of-range test results, and reminding the medical office of guideline-based screening tests or treatments.

According to that report, Electronic Health Records were more commonly used by physicians in primary care (21%) compared to specialists (15%), practices with more doctors (50% if over 50 doctors, a large clinic compared to only 9% in offices with 1-3 doctors), doctors practicing less than 30 years (20%) compared to more than 30 years (13%), and western offices (22%) compared to northeast, Midwest or south (15-17%).

Why is this? Most doctors have been trained at a time when doctor’s offices and hospitals were not computerized. So they question whether it’s necessary to change a simple paper-note system and their practice pattern that they have used all of their professional lives. The cost of Electronic Health Record hardware and software is considerable, often more than $50,000 per physician and with a yearly maintenance fee that is often $10,000 per physician. With healthcare modernization resulting in lower payments to physicians, many doctors cannot afford this investment or expense. Large clinics can more easily afford this expense than small offices with only 1 or 2 doctors. Also, many doctors are afraid of security issues, inappropriate record disclosure, and illegal tampering.

Why are Electronic Health Records good for you? Importantly, you can read the record and know if there are any errors. Correcting an error such as family history, medication history or even allergies can prevent potentially fatal side effects, physician misdiagnosis, or ordering the wrong tests at the wrong times, You can better understand what your doctor is planning for you, and know if your doctor has explained everything to you.

Medical errors are reduced by Electronic Health Records. The nurses and office staff of the physician can read and understand the treatment plan and doctor’s instructions and make fewer errors in coordinating your care. Other consulting specialists can read the record and understand what your doctor is doing so that they can coordinate their care with your current physician. Medical communications are enhanced not only within the office, but also between the doctor and the insurance company, consultants, second opinion physicians, hospitals, and supportive care agencies (such as rehabilitation, home care agencies, pharmacists, medical supply companies, and/or social services departments).

Furthermore, Electronic Health Records enable the physician and medical clinic to check that your care is meeting national guidelines for your illnesses and standards of care. Finally, if your doctor has an Electronic Health Record, you can get copies for your home medical record and for emergencies.

So, are there any problems with Electronic Health Records? First, as I have indicated, costs of Electronic Health Records are high and your own healthcare may be more expensive if these costs are passed on to you as a patient. Your insurance premiums may be higher because of requirements from your insurance that physicians have Electronic Health Records.

Theoretically, privacy might be invaded when Electronic Health Records are used. No matter how high the security, there is always a chance that your private records might wind up in the hands of a “hacker” or accidentally in the hands of someone else. Make certain that you understand the privacy policies in place at your doctor’s office.

What should you personally expect from Electronic Health Records?

1. Does your doctor have an EHR? Yes is good. No is bad.
2. Can you get a copy of your Electronic Health Record? Yes, good. No, bad.
3. When you read your Electronic Health Record, can you understand it? Do the plans and treatments seem logical to you and make sense? If yes, good. If not, you may be getting poor quality care. Discuss this with your physician and make certain that you understand what is in your own medical record.
4. Can you ask your doctor to correct errors in your Electronic Health Record (for example in your past medical history, family history, or social history)? Let the office know, in writing if necessary, what wrong information needs to be changed.
5. Has your doctor sent copies of your note and test results to other physicians and/or health agencies helping to care for you?  If your doctor has not, make certain that the office forwards your reports to all the members of your health team, or have the office make a copy for your own record and then make copies to give to all your other doctors and specialists.
6. This is perhaps the most important. Does your doctor or his clinic check your Electronic Health Record to make certain that the quality of your care is compliant with national guidelines? If your doctor does not do this, ask the physician what steps are planned to make certain that your quality of care is compliant. If the doctor has already done this, be reassured that your doctor is using the most up to date methods for you. If your doctor checks, very, very good. If not, very, very bad (and even consider getting a second opinion from a doctor who does check his patients to be certain they are meeting national quality standards).

Another important digital doctoring step is your doctor’s website. Having a website is not critical to your medical care, but it is good to know that your doctor is proud of his training and reputation, and respects his patients enough to have made the effort to make a website. An office website helps patients understand the office personnel, the doctors background and experience, and the practice policies and programs so you can be more confident your care is highest quality.

This weeks’ take home lessons: Get a copy of your office or hospital Electronic Health Record, ask questions based upon what you have found, and make certain that this copy stays with you for emergencies or disasters.