Early in 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA). Commonly known as the Stimulus, or Recovery Act, it was intended to juice the sluggish economy, and it reached into all corners of our culture. One of its effects on health care was the establishment of a national electronic medical record (EMR).
Financial incentives were provided for medical providers to transition to electronic record-keeping. Well-designed and well run e-record programs improve efficiency and enhance patient safety, but they require conscientious attention on the part of designers and providers.
One such provider, a cardiologist and a fan of EMR, recently had an experience that prompted him to wonder if electronic record-keeping systems should be considered medical devices, and therefore subject to all the same kind of regulatory oversight given, say, a heart defibrillator.
Dr. Wes Fisher received a medical record from a major medical center that employed an EMR manufactured by a well-established, billion-dollar corporation. As recounted on KevinMD.com, he saw “one of the better examples of how EMRs are contributing to misinformation and confusion when health-care is delivered.”
The report was an internal medicine consultation of a hospital patient whose “medications” portion of the internist’s notes are posted on the KevinMD website exactly as received in the EMR, and identified as “Active Medications.” All told, 55 entries for medications were listed, and Fisher was “terrified.”
Some medications were listed multiple times, sometimes with different dosages. Some drugs lacked dosages, such as warfarin, a blood-thinner that must be carefully dosed and monitored. Meds typically prescribed for outpatients are listed along with those typically prescribed for inpatients, making any reviewer of this record unclear what meds this patient is actually taking.
Fisher in no way excuses the internist, or any other doctor, from responsibility over the quality and accuracy of any medical record, whether it’s confined to an office or disseminated to other providers, facilities and insurance companies. But his overriding concern is that when EMRs are poorly developed and/or hospital administrators buy products capable of providing “useless and potentially lethal information about our patients” (his italics), doctors must speak up.
“So how will we measure problems with EMRs?” he asks. “It seems industry representatives would rather not address these concerns. We should ask ourselves, is anyone thinking about this?”
Fisher suggests the creation of an EMR registry similar to the data repository mandated by the Center for Medicare & Medicaid Services (CMS) for implantable cardioverter defibrillators (the ICD Registry). Its purpose would be to track adverse patient outcomes resulting from software systems and would enable EMR manufacturers to learn and improve from everybody’s mistakes.
To learn more about your rights in compiling, keeping and disseminating your medical records, read our newsletter article, “Why Getting and Reading Your Medical Records Can Save Your Life.”