VA and Electronic Medical Records

I find the type of mistake that resulted in the lawsuit filed against the Veteran's Administration last week puzzling given that the VA has had Electronic Medical Record software since 1999. For those who aren't familiar with the concept, an April 10 Washington Post article gives a very good description of the problems EMRs were intended to solve.

In the popular mind, the chief deficit in medical records is legible handwriting. But that doesn't begin to describe the problem.

Many hospitals have multiple paper charts for each patient -- one for hospital stays, another for clinic visits and others for specialty services such as physical therapy. Information is passed via carbons, faxes and letters.

The charts themselves are often maddening arrays of paper held together with metal tabs and wheeled in groups by shopping cart from file room to consultation room. (Before the VA got its electronic system, only 60 percent of patients' charts could be found on any given visit.) Looking at X-rays and imaging scans is equally inconvenient and unpredictable, requiring trips to a film library and luck that the right folder can be retrieved.

The article also goes on to mention that ultimate demonstration of the power of the EMR: disaster recovery as demonstrated after Hurricane Katrina. Given that EMRs can literally be lifesavers, why are only 10% of providers and 5% of hospitals taking advantage of even a limited subset of features?

There are two major reasons. First, surveys from a variety of groups suggest that patients don't trust computers to keep their health information secure. Frankly, living as we do when identity theft is an ever-present worry, it's difficult to blame anyone for being concerned; the VA alone "has investigated 20 complaints of security breaches [in the last 2.5 years], [s]eventeen...[cases of] patient records [being] accessed by unauthorized people, and three...[of] release of medical data to third parties without patient consent."

The much more significant reason, however, is that providers outside of large group practices simply aren't organized enough and don't have the resources required to implement a real EMR.

While EMRs are, at best, rare, more and more people have access to Personal Health Records through their insurers or employers. These pieces of software have nowhere near the functionality of EMRs. The key distinction is that EMRs are maintained by providers and are intended to take the place of paper medical records. PHRs, however, are either maintained solely by the individual or are fed by claims data; details can generally be entered by the individual, but otherwise only a list of visits and, in some cases, prescriptions and lab results can be viewed. They also do not offer the same opportunities to improve patient safety by making it impossible for a busy doctor to, for example, prescribe a medication to an allergic patient.

Of course, as the VA lawsuit demonstrates, medical errors will happen no matter what technology is in use, and lack of functionality is no reason to choose not to use a PHR. I just think that the distinction is an important one, particularly as health insurance carriers like Aetna tout their PHR functionality as a major selling point.

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Related links - Terminology

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