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Do EMRs improve patient care and reduce costs for all medical specialties?
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EMRs will usher in future of health care
 Michael F. Chiang |
Medicine is more complex than ever before. Patients are living longer, suffering multisystem complications of chronic disease and being cared for by multiple subspecialists rather than single family doctors. Furthermore, the quantity of biomedical literature has doubled every 10 to 15 years for the past 400 years. Highly publicized Institute of Medicine reports have identified major shortcomings in patient safety and deaths caused by preventable medical errors. Together, these factors are generating an enormous volume of data from clinical evaluations, laboratory tests, imaging studies and scientific literature that has become impossible to manage using traditional paper-based methods.
Virtually all ophthalmologists are old enough to remember an era when banking was performed manually, when students wrote papers by hand and when airplane reservations were made by telephone. In the same way that modern information technologies have revolutionized these other industries, electronic health records will provide critical benefits in communication among physicians, universal accessibility of medical data, infrastructure for clinical research and adherence to evidence-based guidelines. By developing strategies for embracing these new technologies, rather than clinging to 19th century methods such as handwritten charts, physicians will create unprecedented opportunities to improve the future of health care.
Michael F. Chiang, MD, is Herbert Irving Assistant Professor of Ophthalmology and Biomedical Informatics, Columbia University, New York.
No scientific data to support switch to EMRs
There have been no scientific studies that support that EMRs increase physician productivity, access to care, quality of patient care or better communication of medical information. At this point, it is all just theoretical and anecdotal. Many feel that EMRs will actually increase health care costs.
 Steven A. Nissman |
We know from a recent AAO survey that fewer than 20% of ophthalmologists currently use an EMR system, and only 34% of users feel that it increases their productivity. Government incentives would admittedly make only a small dent in the massive cost of converting a practice to and maintaining an EMR system, so this makes it very difficult for most physicians to justify.
The primary theoretical benefit to EMR use is data exchange. This is a grand idea. However, this would require a single uniform EMR system to be used nationally. Currently there are dozens of software companies selling EMRs, and none of them are compatible with one another. By having physicians and hospitals convert to a wide myriad of different software systems now, we are only further fragmenting the global access to health information in the future.
We are trained to make changes in our clinical practice because they are supported by evidence-based data, not by government mandates.
Steven A. Nissman, MD, practices at Nissman Eye Associates, Plymouth Meeting, Pa.