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Electronic medical records: are we there yet?

In a happy coincidence, my favorite blog fodder feeder sent me a link to an article about Kaiser Permanente’s electronic medical record woes a day prior to Dr. Feld’s latest post on the subject of EMRs. Dr. Feld’s thoughts on the matter will certainly help to round out this discussion.

I’ve always been fascinated by technologies that are ahead of the curve. I blame this on my parents (take note – parents can be blamed for good things). Growing up in rural Canada our family was ahead of the tech curve – we had a satellite dish before there was scrambling, we had the very first Apple computers at home, and we built our own yogurt factory complete with an advanced digitally automated temperature gauge system, before the rest of the industry had moved beyond millimeters of mercury.

In college I was the first kid with a laptop in class, and in med school I was one of the first with a PDA. I took a portable printer with me to Europe in the late 80’s to go along with my Wordstar word processing program. I thought I was pretty cool, I guess! Stirrup pants, granny boots, permed hair and pink lip gloss.  Those were the days.

Cliff Bassett recently asked me why I was working at a new company (Revolution Health) that was so cutting edge rather than remaining in clinical practice. I had never thought about why I did it before – but now I see that it was part of my pioneering pattern. There’s nothing more fun than being ahead of the curve… but it can be aggravating as well.

Technologies are awkward for their first adopters – they aren’t streamlined, they can actually take more time rather than saving it, and they can make communications with others (who don’t use it yet) more difficult. But a few of us do it anyway – we jump in head first, believing by faith that the enterprise itself is worthwhile and that once we get to version 3.0 we’ll be sitting pretty.

But what do we do when we’re at version 1.0? Normally, we just tear our hair out and send lots of “bug alert” messages to developers. But when the technology affects someone’s health, the bugs are a lot more sinister. The recent article about Kaiser Permanente’s digital growing pains is disturbing indeed:

Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees… Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.

Still, 90% of physicians use paper records, making it difficult to share information – and this is no doubt contributing to the IOM’s estimated 98,000 error related deaths/year. Dr. Feld explains the complexity of a fully functional electronic medical record:

However, a paperless chart is in reality worth little unless the information entered is usable in a relational data base format rather than word processing format. Only then, can patient care be enhanced…An effective Electronic Health Record must consist of five components

Electronic Medical Records
Personal health records (PHR)
Continuity of Care Record (CCR)
Electronic health record (EHR)
Financial Management Record (read more…)

So, the bottom line is that the EMR is in version 1.0 at Kaiser Permanente, and only a twinkle in our government’s eye. It is complicated to create, nearly impossible to coordinate, dangerous if implemented half-way, and yet utterly necessary for ultimate cost savings and patient safety.

What can we do between version 1.0 and 3.0? Prayer and vigilance come to mind… it will be up to the foot soldiers (the docs, nurses, and hospital staff) to keep patients safe while juggling paper and digital until digital can fly on its own.

How do you think we can minimize our digital growing pains?

This post originally appeared on Dr. Val’s blog at

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5 Responses to “Electronic medical records: are we there yet?”

  1. ValJonesMD says:

    Well good for you, Dr. Smith, for being a pioneer yourself! We are a long way from the EMR promised land, but companies like Revolution Health are walking the desert trek along with you! Making medicine electronic is the digital version of America’s Transcontinental Railroad. Right now we have a “fax your record” capability at RHG (so at least people can keep all their paper records in one place on the net), but this is only the first step…

  2. Dr Rob L says:

    You have a subject here that is dear to my heart. We have been on EMR for 10 years and have been awarded by HIMSS and NCQA for the quality of our care. We are operating at a much higher level of efficiency and at a much better quality than most practices (certainly the combination of efficiency and quality is extremely unusual). While Kaiser’s experience is poor, it is very possible to succeed with EMR. Our office is but one example. The only thing holding us back from even higher quality is the fact that we would have to lose money to do so. We did just get our first $5000 check for quality, however, and I suspect it will be easier to motivate physician change when they see more of that kind of thing. I always find it amusing when other’s say it cannot be done. It can, and it will be increasingly required by the government (I know that because I am involved with the government at various levels and they clearly see the need for EMR and changing incentives for physicians). Yes, there are a lot of bad stories like Kaiser (although there are plenty of physicians within Kaiser that would tell you a different story), but there are also success stories like Providence in Portland, or MeritCare in MN and ND.

  3. ValJonesMD says:

    Thanks for sharing, Dr. Rob! So you’ve had a peak at the promised land… Would love to hear more about what works and why. I spent the last 3 years at a hospital that had NO electronic records of any kind – eek. Our clinic patients would literally break down and cry some days when I had to tell them that we couldn’t find their chart and they’d have to explain everything from the beginning… again. It was so painful.

  4. Hashslingingslasher says:

    I made my choice of physician based in large part if they were using an EMR. The safety issue was and is paramount. I don’t believe that EMR’s make bad physicians into good physicians. An EMR will not substantially help.

    However, I do believe EMR’s make good physicians, better.

  5. lex72 says:

    We all have to take part in fixing the system, the first step any person can take is by creating a digital health record , this does two important things first it reduces medical errors and second reduces costs so that duplication of services are less likely. It also puts the patient/ consumer in more control of his information which is a powerful tool. A good example of this which is currently free to the public is It potentially could save millions of dollars if the public would just take responsibility for there own health, and it starts with the medical record.

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