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The wrong argument against EMRs

August 24, 2010

Jay Parkinson recently posted a video about ePrescribing on the iPad.  He subsequently pointed out that, “When doctors use computers, their productivity decreases by 18%.”  Typing a prescription into a computer, when compared to illegibly scribbling it on a prescription pad, is less efficient.  This fact is not in dispute.

Such decreases in productivity are often cited in arguments against the adoption of electronic medical record (EMR) systems.  Unfortunately, this takes a “physician-centric” approach to the problem (not an uncommon occurrence in health services research).  Everything that happens subsequent to the physician writing (or typing) the prescription is more efficient when done electronically.  The prescription is transmitted immediately to the pharmacy–doesn’t need to be “called in” or faxed over or handed directly to the pharmacist–where the pharmacist can easily decipher the order and immediately begin filling it.  The prescription is automatically added to the patient’s chart, where normally the physician or (more likely) their nurse must manually put it into the correct place in the patient’s paper chart.  Additionally, if we had inter-operable EMR systems, other physicians who are part of the patient’s care team could automatically have their records updated to reflect this new prescription.  In fact, the original physician’s productivity is increased when the patient needs a refill because this order can be completed with the click of a button.  And probably the most often overlooked benefit of electronically filling such orders is the potential for research.  Electronic records–especially prescribing data–facilitate all kinds of research, from trending usage patterns of certain drugs to continual monitoring for adverse events related to recently approved drugs or medical devices (so-called “Phase IV” trials) and even comparative-effectiveness studies of two different therapeutic modalities (which can eliminate the need for a long, expensive controlled trial) .  This type of research with paper records requires the labor intensive process of flipping through charts, finding the relevant data, and recording it in a separate database for later analysis.  This is expensive and tedious, therefore it often is not done at all.

Unfortunately, current EMRs don’t come close to working this smoothly.  The current mélange of paper records and incompatible EMRs is inefficient.  But, if we let these deficiencies slow down innovation and adoption, we stand to lose one of the biggest opportunities to improve health care.  Arguing against EMRs today is the equivalent of saying in 1995 that AOL and Netscape are crappy so let’s not invest in tech companies.  Wider adoption and better design are needed for true, system-wide improvements in efficiency.  More importantly, we need to keep in mind the potential benefits in the broadest sense, not just the 20 second difference between writing a script and entering it electronically.

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