I recently attended an industry sponsored event on Health Information Technology (HIT) and the Electronic Health Record (EHR).  The electronic health record refers to the ultimate goal of HIT, where a patients entire health history, treatments, prescriptions, etcetera will be available in a single accessible electronic file. Many of the 

While the process will certainly be a long and arduous one, the final product will be one which will benefit both physician and patient.  No one can argue that patient safety will be improved by the elimination of common human errors, such as incorrect medication administration due to handwriting errors, but the process of moving to a completely electronic health record will have errors and problems of its own.  Because the shift to EHR will require a redirection of work flow in the office setting, errors will no doubt be made as health care providers and staff will placed in new roles.   The good news is that many of the common computer errors, such a mis-key errors, will be identified and corrected almost immediately, usually before the patient has left the office.

Orthopedic surgeons are often at the forefront of technology development and implementation.  The astounding technical developments in arthroscopy and computer aided surgery surely support this opinion.  This willingness to embrace and use new technology will be of great benefit in the transition to a paperless environment.  Many young surgeons coming out of training are already familiar with electronic medical records (EMR), and many older surgeons are currently installing an EMR system in their offices.  The EMR is a vital component of the EHR and represents what would be traditionally referred to as the patient chart.

Despite this, there will be surgeons that oppose EMR because they say it makes them less productive, it takes too much time to generate notes that are too impersonal or that they are simply too old to learn a new system of charting.  While there can be no doubt that during the implantation of EMR, the surgeon will have to reduce his workload as every patient must be entered as new patient into the EMR system, studies have shown that the computer will provide more accurate encounter coding, and thus improve collections on the documented encounters. As one becomes more familiar with an EMR system, templates can be customized, redundancies deleted, and positions of vital pieces of the EMR known.  Ultimately, this should lead to shorter charting times and increased efficiency.  Customizing templates, as well as the use of speech recognition technology and free text entry can be used to personalize notes or fill in the gaps wherever the electronic medical record falls short.

To make this transition to EMR as painless as possible several pieces of advice have been offered.  First, choose a company carefully - there are many companies out there offering programs which may or may not be obsolete in the coming years.  The ability to seamlessly integrate into a practice’s existing billing and scheduling system should be an important consideration in the final determination of provider.  While there is no doubt that different versions of the EMR program and updates are inevitable, it is important to try to ensure that these program upgrades do not bring about unforeseen “crashes” in the business office.  Next make sure that the company is dedicated to support and customer service.  The implementation of an EMR system will be trying enough without the added stress of “flying solo” and attempting to figure out the nuances of a charting system.  Finally, if you are a member of a group, there should be one to three “champions” of EMR.  These are partners who will act as both cheerleaders for EMR, as well as a sounding board for the complaints and concerns of frustrated partners making the transition to a paperless world.

Ideally, when fully implemented, EMR will provide the physician with the ability to order tests, update demographic information, write prescriptions and have them sent to the pharmacy, and schedule procedures before the patient leaves the room   Additionally, the EMR will possibly allow the access to patient records to approved providers on a 24 hour a day basis.   The patient’s exact history will be easily obtained, allowing the on call physician to make more educated decisions without having to rely solely on the recollections of the patient as to what they are being treated for and what procedures they may have had.

I am currently beginning to implement EMR in my office, and then I have to try to integrate twenty plus partners into our EMR system.  While I do get discouraged at times, the obvious benefits of EMR keep me trying.  Wish me luck (I need it!), and I’ll let you know how it goes.

Click here to view more articles in the October 2006 TSSM Newsletter.
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