Myth 1: An electronic medical record could save your life in an emergency

Information technology does not stop bleeding, start IVs, defibrillate the heart, or put in a breathing tube. In an emergency, those are the things that save your life. If you need them, the doctor does not have time to look at your EMR.

In an emergency, the doctor needs to know your blood sugar NOW, not what it was 6 months ago. Ditto for your chest xray. If the test needs to be done STAT, the old results are probably irrelevant, and if it doesn’t need to be done STAT, there’s time to make a phone call and ask for a faxed report.

The most important information in an emergency is what just happened to you, and that will not be in your EMR.

If you have a serious allergy or other problem that your doctor needs to know in an emergency, wear a MedicAlert bracelet or something else attached to your body. In a bad emergency, your ID may be lost, the computer may be down, or the power may be off.

The EMR is being promoted for the convenience of bureaucrats and lawyers, and for the profits of vendors. Sometimes it helps doctors; sometimes it’s a hindrance. Only the doctor can decide.

The EMR costs a huge amount of money, and the costs never stop. It might save a few dollars in preventing unnecessary tests for people who have bad memories or can’t keep track of paper records.

The whole record could be destroyed by a power surge (especially if it’s an electromagnetic pulse or EMP). Or it could become unreadable; tapes, disks, and other media become obsolete and are not necessarily durable. On the other hand, it can be nearly impossible to extirpate errors.

The EMR may prevent some errors, but introduce others, especially ones caused by identity theft, sloppy data entry, poor typing skills, confusing software, dry-labbed information entry by macro, and failure to check data once entered. It could even kill you.

EMR systems are a nonconsented experiment, the results of which may be kept secret by the vendors.

If you’re desperately ill or critically injured, you need a doctor, not a computer. Your doctor needs to be able to keep his records in a way that works for him, and to choose his own tools, computers included.

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13 thoughts on “Myth 1: An electronic medical record could save your life in an emergency

  1. Electronic records can be helpful. As an anesthesiologist, electronic capture of physiologic parameters during emergencies can be very valuable. Digital x-ray allow almost immediate results to be seen on computer monitors. EMR allow remote site review. That being said, there is a lot of “cut and pasting” that propogates errors and does not truly indicate the progression of problems. Additionally, there tend to to be more and more templates created that remove flexibility from the record.

  2. Aggree with above–EMR is EXTREMELY DIFFICULT TO READ! HARD TO GET TO THE POINT-IE WHY PT EVEN CAME IN!! May also contradict itself-if the reader doesn’t read the WHOLE doc. may not know what pt status is–may not know if reads!! History/allergies good-but may not be current…a slippery slope M Sloan

  3. I have looked at most of the EMR on the market. The only advantage I can see is if they code accurately so that in the event of a Medicare audit we have made the bureaucrats happy. The EMR from our ER is worthless. Routinely I would find a patient who came in comatose described as A&O x3 and Psych normal. EMR is about like DOS 1.0. It could be so much better, but since the EMR developers know that the govt. will force people to buy it, even if it is junk, they have no incentive to build a good one, and never will.

  4. I am glad you have the courage to write about the need for medical records. I have always wondered about this situation. All burocrats making all this big deal about medical records importance. To say the truth, in my practice I rarely have the need to check medical records. Most of the time it doesn’t make any difference for my understanding of the patient and the care I deliver. I always have wondered about this but never said anything in view of the fact that all so called authorities make such a big deal of it and one would look really incorrect. I think that the importance of medical records has been oversold in this country, especially by those people who find pecuniary and other kind of interests by promoting it. The decision to use medical records depends on the individual physician. I always have had trouble to imagine an ER physician looking at medical records while he has a patient in need in front of him.

  5. EMRs can be helpful but they can easily over-document JUNK. I review medical records on a daily basis which have been scanned into the computer for disability claims. The ABSOLUTE WORSE EMRs are from the Government VA system. It’s like being in purgatory to try to glean any useful info about the patient from those records which typically can run up to 100 pages or more for a routine patient without significant medical problems or complications for just a few years. They are not always chronogical, not categorized by type of document and they “run on” with out clear separation by date, type, etc. I see other EMR records where, for a SINGLE outpatient visit, it can take up 6 pages to document really not much of anything with maybe a few sentences of semi-useful patient information about that visit. The biggest flaw is the default documentation (to satisfy the “bullets’ needed for reimbursement) that automatically spits out canned exams unless the provider actually makes an effort to amend it. Similar to what was noted above by Ed Charnock, I’ve seen motor and gait as ‘normal’ for a known quadriplegic. That makes deteriming disability a really tough job. The other big flaw is the “copy and paste” of histories and exams—the same blurb that can be endlessly repeated for years, (only the BP and pulse may change). Also original diagnostic impressions are carried through endlessly even though resolved, changed or irrelevant. I have used EMR in clinical practice, but it’s not all that user friendly in an emergency. It’s good for getting test results. For my own mother, I have typed up a well-organized, ‘doctor-friendly’ medical and surgical history, medication list, personal Hx, her list of doctors, family contacts (on a total 2 pages) and have copies available for her whenever she goes to the doctor or ER. I keep it revised. It can also be put on a flash drive. With that info in hand, the doctor only has to concentrate on her current problem instead of wasting time extracting past medical information or going through her rather extensive, complicated medical records.

  6. Sick and or injured patients need a living, breathing, THINKING well educated professional who understands the structure and functions of the human organism who uses all his senses to evaluate the patient in the light of his knowledge and then proceed to use that knowledge to treat the problems at hand. The governmental approach is designed on the premise that only they know what should be done and therefore they issue edicts in the form of protocols that cover every problem they can imagine. The physician’s role is to obey not think. If there are individuals who are willing to work that way (in a non-religious sense) God help them and the poor devils they attend.

  7. “All generalizations are false” – and since this is a generalization – !

    Specifically, in primary care, I developed in 1967, 1991 and 2005 EMR systems, last cost ~ $5,000 (for 2 tablet PCs), and printed ONE (the only) page for the patient.

    Now, (3 years) I write on the same Patient’s Record matrix
    (new sheet each visit) and keep a cc. This preserves privacy – and all benefits of EMR.

    In anesthesiology (what privacy is there in a hospital gown? ) I would use EMR.

  8. An improved and readily available electronic medical record system will save time and money.

    As an Emergency Physician I have seen countless tests repeated or obtained unnecessarily due to information that was not available.

    Does this patient always have abdomen pain? Have they already had a GI work up? What were the results of that heart cath from last year? Do they have an underlying anxiety disorder that often manifests with SOB?

    The results of old CT scans, EKGs and Chest Xrays will save us time and money. Not to mention a quality system will help prevent patients from obtaining narcotics and other medical care under false pretenses.

  9. Greater coordinated care can be achieved by interfacing the EMR system with hospital
    clinical applications, resulting in a more complete care assessment and reduced
    critical errors.Hence it must be implemented.

  10. EMR sounds good in theory, just like Esperanto and the United Nations. The problem is that current systems don’t work very well and often actually impede communication at the bedside. Vendors of EMR systems tell me it will take my office 6-12 months to be able to competently use their system which in the interim will reduce office productivity. If a system is so sophisticated, why does it take staff 12 months to learn to duplicate current processes while incurring significant hardware and software expenses?

    On the hospital end, navigating through the vido display fields jungle of a chart sometimes becomes vastly more challenging than caring for your patient, robbing valuable time from more important tasks. In the operating room I’ve noticed that hospitals with computerized charting have turned the circulating nurse into a cyberclerk. For shorter cases they often have trouble finishing the charting before the operation is over, let alone participating in the care of the patient during surgery. As others have noted above, besides getting personal health information that any patient can keep on a single piece of paper or a smart card, the factors affecting care of the patient are typically those of the moment, not the remote past.

    Automation and robotics have much to offer in terms of efficiency. Most industries however do not adopt these modalities until they can conclusively demonstrate significant advantages over existing systems: cost savings, improved quality, greater productivity. What we are seeing in medicine is the effort of systems analysts and policy wonks to push information technology onto healthcare to advance political and policy objectives more than to contribute to quality of care. By computerizing medicine, the government can remotely analyze the data to control providers and ration care. Since all the data will be instantly available, there will be no place to “hide”. Outliers from government imposed parameters will be flagged and punished. We are already seeing this is type of issue emerge in Massachusetts. While there is an advantage in avoiding duplicative testing and medication errors, that is not the impetus for EMR. Plus the costs to create massive new bureacracies to monitor and control the medical record will cost an enormous amount of money. No demonstrable efficiency there.

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  12. I find the electronic record useful only if it allows me to type a note.

    If entry of information into a template is required, the electronic record slows care.

    While I like typing for legibility, I think a more important consideration is loss of privacy. Records should be encrypted, controlled by the patient, and the patient should decide whether a company or a government should have an electronic key. Does this suggestion run the risk of havning no information in an emergency? Yes. As a patient, such is my choice. You could refuse to have your information encrypted.

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