A history of Computing in Medicine
Electronic Medical Records
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- Benefits
- History of the EMR
- Drawbacks of EMR Systems
Electronic Medical RecordsBack in 1960, an article in the New York Times mentioned a Tulane University Medical School doctor's vision of "medical records stored on tape, or in other ways appropriate to computers, [that] might ultimately replace written records of medical patients altogether"Error: Reference source not found. A 1967 article in the same publication mentioned that in the future, "every man, woman and child may have his entire medical dossier electronically recorded in a gigantic memory system in Washington"0. It went on to discuss the benefit of such a system if a person were to have a heart attack while on vacation in another city: "the attending physician could simply telephone to Washington and in seconds have his patient's full medical history before him". Today, 40 years later, we have yet to see widespread adoption of such an electronic medical record (EMR) system. In addition to the remote access benefit mentioned above, EMRs offer numerous other advantages27 which are discussed in the following section. Based on these benefits and the fact that the idea of electronic records has been around for decades, one would think that EMRs would be widely implemented by now. While some industrialized countries such as Britain and the Netherlands are way ahead in this arena71, the adoption rate in U.S. clinics is only around 17 percent28. BenefitsThe main consumers of an EMR system are doctors and other clinical staff. A basic EMR system allows these professionals digital access to an electronic version of a patient’s medical records, the same type of data that for years has been stored on paper. So why change something that has been working for so long? Iatrogenic, or physician-induced, complications from errors such as over-prescription or drug-drug interactions are, unfortunately, common, and a big problem in today’s medicine. Electronic records combined with clinical decision support systems (which are discussed in a separate section) are able to provide automatic checks to help prevent these types of mistakes and reduce the number of medical errors. Either a single national medical record database, or a network of private electronic record systems that can interoperate with each other, would offer a distinct advantage to anyone that travels. As mentioned in the opening paragraph, a person's medical records would be instantly available at any place and any time, allowing for a better quality of care. Such a network would also foster better coordination of care among different specialists. If the EMR system can also interoperate with other types of computerized clinician assistance tools, the efficiency of care coordination can be further boosted. EMR systems linked to clinical lab systems can make visits to the doctor go more smoothly when lab work is required. Without such a system in place, the doctor usually fills out a request for the lab work which the patient then carries to the lab. Once the lab work is completed, the results are delivered back to the doctor to be put in the patient’s paper file. This is a tedious process and can encounter problems such as misread handwriting, paperwork lost in transit, or results not being file correctly. Using an EMR system, physicians can place electronic requests for lab tests. When the results are ready, they can be sent back and stored in the patient’s electronic file. Some systems can notify the patient that the results are ready and may even provide a means for the patient to check results over the telephone. EMR systems allow for computer-printed prescriptions. Physicians are notorious for their bad handwriting, and their handwritten prescription slips are no exception. Consequently, pharmacists may misread drug names or doses, which in some cases can lead to adverse results. There are numerous accounts of malpractice suits as a result of misread prescriptions. Computerized systems can alleviate this issue. In addition, the paper on which prescriptions are printed can also have security features built in, helping to prevent forgery. An EMR system can be a great resource for patients that want to view their medical histories. Currently one has to request physical copies of their records, rounding them up from every clinic they have ever visited and jumping through administrative hoops. With an electronic system, a patient can have web-based access to all their medical data, allowing them to view trends in weight, condition, blood pressure, etc. This information could be accessed from any place in the world that has a computer and an Internet connection. EMR data can be backed up and stored offsite from the hospital, providing safety in the event of a natural disaster. Hurricane Katrina resulted in the loss of thousands of medical records due to flooding, not to mention the security jeopardization of private patient data. Sites that were using electronic medical records were able to recover their records from an offsite backup location. As more and more facilities begin to implement EMR systems, we will eventually get to a point where hundreds of thousands or even millions of records are stored electronically. If we can strip these records of identifiable markers, to alleviate privacy concerns, and somehow pool these resources, we could have a very large bank of mineable data. Mined data could potentially lead to a better understanding of what causes certain diseases, for example, or which treatment courses work best for a given medical profile. While the up front cost of implementing an EMR system is prohibitive, it is thought that over time that money would be recouped. The increase in efficiency, for example, means that fewer human resources are needed. In addition, the savings from reduced litigation in regard to iatrogenic errors should be substantial. EMRs can offer administrative and management benefits to an institution. For example, they can be used to track the number of procedures performed, complication rates, average time to resolution, and even physician performance. Health insurance companies can gain productivity from an EMR system as well. They can use the system for direct customer billing or to alert doctors of policy changes. Although some might argue that insurance companies should not be driving patient treatment, this is a fact of today’s medical system. For example, if a new policy requires that a certain medication be prescribed as a generic, the prescribing doctor can get immediate notification of the fact when entering the prescription into the patient’s record. Or, perhaps a patient’s insurance company does not cover certain medications or treatments. This type of information would also be instantly available to the prescribing physician. Clinics can also utilize EMR systems to their advantage to settle insurance company disputes. One group of clinics in New Jersey was able to push back against certain insurance company compliance change requests by mining the data in their own EMR system to prove that they were already in compliance29. Without the EMR system, the clinics would have to have done much more work to prove their position, relying primarily on insurance billings and on data from the insurance company. History of the EMRA programming language called the Massachusetts General Hospital Utility Multi-Programming System (MUMPS) was developed in the late 1960s for use in health care systems. It did not become widespread until the 1970s, when it was used to build many clinical applications. Today, some older systems are still running software that was built using MUMPS. While MUMPS was originally used for medical records, it is now widely used (under the names M and Cache30) in other places where simultaneous database access is required, for example at banks, stock exchanges and travel agencies.31 In 1978, Joseph (Ted) O'Neill and Marty Johnson and a host of others began work on what would eventually be called Fileman. It was built using MUMPS and was a set of generalized routines that anyone in the Veterans Affairs (VA) Department of Medicine and Surgery could use. A lot of small tools and systems were built using Fileman in the late 1970s and early 1980s. It was later adopted by the VA as its official medical program. In 1981, Mickey Singer started a software company in Florida called Personalized Programming Inc. This company was one of several companies which ultimately merged to form Medical Manager Inc. They provided proprietary medical practice software to medical practices all across the United States. This software took the market by storm and by 1997 about 24,000 clinics and 110,000 health practitioners were using the system. The Medical Manager system has had its ups and downs and today it has largely been abandoned by most of its users. Stepping in to fill its shoes are open source General Public License (GPL) solutions that allow clients to get away from the proprietary nature of the software. Today there are multiple companies competing for a piece of the EMR pie. Some reports count anywhere from 250 to 500 different companies offering EMR solutions. Some software is focused on a small portion of the EMR system, for example prescriptions or health history, while others focus on packages that cover everything from start to finish. Software giant Microsoft Corporation has also realized the potential for medical software and in July of 2006 purchased Azyxxi, an EMR solutions company whose software is currently in use at seven different hospitals in the Washington D.C. and Baltimore areas. Microsoft has created a health care software division and expects to spread their technology nationwide. It will be interesting to see what happens with a company this large throwing its hat into the arena. Drawbacks of EMR SystemsDespite all the benefits of EMRs, there has been low and slow adoption of these systems. We discuss some of the reasons for this. A lot of the current EMR systems on the market do not interoperate. There is little incentive, from a clinic’s perspective, to interoperate with another clinic’s computer system. If interoperability and transferability of records makes it easier for patients to switch to another clinic, it creates a conflict of interest. A growing trend in America today is electronic privacy concerns. These concerns are especially prevalent in the realm of electronic medical records. If EMR systems interoperate so that one clinic can share information with another clinic, how do these clinics ensure that private data remains private and can only be accessed by the appropriate people? How easily can these systems be hacked? What other kinds of digital security issues do they present? These are the types of questions that concerned citizens have about EMR storage. These issues could prevent the EMR from ever becoming widely adopted in the health care industry. Computerized systems make it easy to enter new data for patients as they come into the hospital, but a medical history that contains only partial information is not that beneficial. In order to reap the full benefit of an EMR system, it pays to have complete patient histories. Getting old data into the system would require manual insertion, a laborious and costly endeavor. This daunting task could also be a factor in the rejection of an EMR system by adding to the overhead of getting the system up and running. Backing up paper records is as simple as running them through a copy machine. For the most part one is likely to be able to read a piece of paper tomorrow in the same way one reads it today. However, the same is not true for electronic content. The backup system and the format in which the data is stored may change. If the technology changes, will the backed up data still be readable in the future? These are problems that clinics and hospitals are not keen to deal with. Directory: courses -> csep590 -> 06au -> projects projects -> The History of Computer Gaming Osama Mazahir projects -> Bui,/Fernandez,/Tran pp 190: The History of Computing projects -> Csep590a history of Computing’s Effects on the Creative Industry Russell Clarke (Microsoft) Abstract projects -> Liya Getachew November 20, 2006 csep590 -> A history of Computing in Medicine csep590 -> Digital Watermarking Tsunoda, Koichi csep590 -> Csep 590 tu project Steganography and Digital Watermarking projects -> History of Computing Abroad Download 135.17 Kb. Share with your friends:
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