The Electronic Medical Record: Efficient Medical Care orDisaster in the Making? Dale Buchbinder You are the ChiefInformation Officer (CIO) of a large health care system. Medicarehas mandated that all medical practices seeking Medicarecompensation must begin using electronic medical records (EMR) .Medicare has incentivized medical practices to place electronicmedical records in their offices by giving financial bonuses tomedical practices that achieve certain goals. These EMR systems aresupposed to allow communication between practitioners andhospitals, so medical information can be rapidly transferred toprovide more efficient medical care. The EMR will enable physiciansto allow access to the records of their patients by otherproviders. Eventually these records are supposed to be easilyaccessed so any physician or hospital will have complete medicalinformation on a patient. The physician practices in your healthcare system have been mandated to use the Unified Medical RecordSystem (UMRS). The UMRS was designed by a central committee; allhospital-owned physician practices have been mandated to use thesystem. As part of the incentives, Medicare will add dollars backto each practice when they meet goals for reaching meaningful use(MU). MU has been defined by the U.S. Department of Health andHuman Services (n.d.) as “using certified electronic health record(EHR) technology to: • Improve quality, safety, efficiency, andreduce health disparities • Engage patients and family • Improvecare coordination, and population and public health • Maintainprivacy and security of patient health information.” It is astep-by-step system requiring “electronic functions to support thecare of a certain percentage of patients” Qha, Burke, DesRoches,Joshi, Kralovec, Campbell, & Buntin, 2011, p. SPl 18). One ofthe hospitals in your system has many primary care and specialtypractices; however, the UMRS system was designed primarily for theprimary care practices. The committee that developed UMRS did nottake into account the needs of the specialty practices, which aresignificantly different from the primary care practices. This issuehas been brought to the fore from by several medical specialistswho have stated UMRS is not only cumbersome, but also extremelydifficult to use. UMRS also does not give the specialist theinformation he needs. Specialists noted that after UMRS wasimplemented, it took them approximately 10 to 15 minutes longer tosee each patient. Since an average day for a specialist consists ofseeing between 20 and 25 patients, adding 10 to 15 minutes perpatient adds 200 to 250 additional minutes, or 3 to 4 hours moreeach day. And, the physician cannot see the same number of patientseach day. In reality, this represents a 30% decrease inproductivity because of the amount of time it takes to use UMRS.Now the specialist office schedules constantly run significantlylater than they should, and patients become unhappy and impatient.Several of the specialists reported that a number of patients havegotten up and left without being seen. In short, the mandate to useUMRS has impacted the efficiency and productivity of thesubspecialists and specialists, further decreasing revenues for thesystem. In addition, all of the physicians have complained the UMRSdoes not communicate well with other electronic medical recordsystems, or even the hospital’s own patient information systems.There is no real integration of the medical databases as intended,levels of meaningful use are unclear, and in some areas, difficultto achieve, again because the UMRS was tailored to primary carepractices’ prescribing patterns. Specialists, particularlysurgeons, do not write a large number of prescriptions. Surgeonshave been mandated to write electronic prescriptions to reachmeaningful use; however, in many cases this is not appropriate forsurgical patients. All of these issues and concerns were reportedto the central committee that created UMRS in response to federalmandates and financial incentives. The committee responded itcannot modify the system to make it more friendly to specialistsand subspecialists, despite the fact that procedures performed bythe subspecialists account for substantial revenues. Revenues aredown and the morale of the specialists and subspecialists hasplummeted to the point that many are talking about taking earlyretirement or leaving the system. Still, the committee refuses tofix the problems. Since you are the CIO of the entire health caresystem, the situation is now in your hands. What will you do?
Discussion Questions
1. What are the facts in this situation?
2. What are three organizational issues this caseillustrates?
3. What are the advantages and pitfalls to EMR? Should all typesof practices be required to use the same system? What role shouldphysicians play in selecting and developing an EMR system to fixtheir individual practices? Provide a rationale for yourresponses.
4. Is there a way to bring consensus and standardize the EMRsystems without alienating productive physicians who bring largerevenues to the hospital? How can the dilemma of inefficiency andpatient dissatisfaction be prevented? Create and present a plan forhow EMR could be implemented in a system with multiple types ofpractices. Be sure to address the issues of physician specialty,productivity, and satisfaction, as well as patientsatisfaction.
5. What steps should the CIO take in the future to prevent thesetypes of issues from occurring again? Provide your reflections andpersonal opinions as well as your recommendations and rationale foryour responses.
