Summary
EMRs have huge potential - improved efficiency, avoidance of medical errors, faster record transfer, improved lab result access, and secure records maintenance. However, the cost both in raw dollars and in time spent rolling out and maintaining such systems is unimaginable. Government mandates, carrots and sticks will all be necessary to prod health systems to move forward.
Analysis
EMRs as imagined by the public are very sexy - a doctor types orders while patients report symptoms; prescriptions are flashed to pharmacies, and all of a patient's healthcare providers are updated and connected real-time as a patient moves through their diagnostic maneuvers. However, back in reality, even moving toward step 1 of developing an EMR is overwhelming: what information does one keep electronically, what "old" info does one upload, who gets access, and how do you maintain it? "Turnkey solutions" are a fallacy to most docs, who are not part of large, integrated healthcare systems, and hundreds of tiny EMRs that don't speak to each other cause huge waste and opportunity cost. When our hospital system rolled out its EMR we were quoted a price of $5-10,000 per physician to start up. This was in addition to the time we needed to spend to train and was separate from the ongoing maintenance. Our system had to function as an EMR, a scheduling system, and a prescribing platform, and had to encompass all medical specialties, from internal medicine to orthopedic surgery to the NICU, all with different visit/procedure types, unit- and weight-based- prescribing, and widely different patient profiles. For example, think about how pediatrics needs different medicines, different dosing and growth charts. Provider resistance was (and remains) huge, and new "modules" continue to be rolled out slowly to accommodate different practices' unique characteristics.
Obstacles remain time and money. Seeing patients efficiently for many (including myself) does not include completing notes prior to end of business, which leads to work-creep and uncompensated work time. Although I would never go back to paper-based charting, there is no question that after 5 years of EMR use, documentation still takes longer than a few lines scribbled on paper.
