Applied Medical Informatics for the Chest Physician
In the first installment in this series on applied medical informatics (AMI) for the chest physician, we reviewed the structure and basic function of the electronic medical record (EMR). Even to the casual observer of the technology of the EMR in American medicine, the following two realities are manifest: (1) recently, there has been a great deal more discussion in the medical literature, in national medical organizations, and in the lay press on the benefits and risks of the EMR; and (2) there has been a great deal more talk about the EMR than has been actual use and availability of these tools in daily practice. In this, part 2 of the series on AMI, we will examine the reasons for this important and frustrating conundrum, and how to understand and realize the benefits of the EMR and avoid its drawbacks. add comment
In his 2005 “State of the Union” message, President George Bush stated: “By computerizing healthcare records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” Juxtaposed with this statement are the following findings from the survey of American Hospitals in 2002: of all US hospitals, only 9.6% of them (60 hospitals) have the computerized physician order entry (CPOE) component of the EMR completely available for use. In about half of these hospitals, > 90% of orders are entered with CPOE by physicians; in about another third of the hospitals, 90% of the orders are entered with CPOE by nonphysician staff.
The causes that contribute to the low rate of EMR implementation and usage include the following:
1. Complexity of the EMR;
2. Cost of change;
3. Time commitment;
4. Clinician expectations;
5. Interoperability (including standards and controlled medical terminology);
6. Understanding clinical workflow; and
7. Competing agendas in American health care today.
Let us examine items 1 to 6 in more detail.