Electronic medical record boosts quality, efficiency

Medical society examines EMR — potential and pitfalls

CHICAGO--Ten years ago, Douglass A. Morrison, MD, PhD, FSCAI, was none too enthusiastic about the electronic medical record (EMR) being developed by the Department of Veterans Affairs for use throughout its health system.

"I thought we would spend a lot of time sitting in front of a computer screen, and it would take us away from patients," said Dr. Morrison, who directs the cardiac catheterization laboratory at the Southern Arizona VA Health Care System in Tucson, and is a professor of medicine at the University of Arizona. "Today I think the electronic medical record enables us to take better care of patients--and to do it more consistently."

Dr. Morrison will talk about why he changed his view at a special symposium on the electronic medical record being held at the Society for Cardiovascular Angiography and Interventions (SCAI) 29th Annual Scientific Sessions in Chicago, May 10–13. He will be joined by co-chairs James E. Tcheng, MD, FSCAI, and Bonnie H. Weiner, MD, FSCAI, as well as representatives from Kaiser Permanente and major EMR vendors.

Not all skeptics have become fans. Electronic medical records are costly, implementation can be difficult and disruptive, not all software is as seamless and user-friendly as it should be, vendors come and go, and the road to universal standards has been long. And, since many physicians practice in multiple hospital systems in addition to their own practices, integration can be challenging.

Some of the EMR systems currently in use result in a significant shift in clerical work to physicians. In addition, cardiology is a field that depends heavily on graphics, such as electrocardiograms, echocardiograms (ultrasound), and angiograms, but many EMR programs cannot yet import or even view graphics. Challenges remain in creating interfaces between existing hospital systems and the EMR that will take further development to overcome. Furthermore, research on medical errors has not consistently shown that the EMR decreases errors.

Still, EMRs offer several potential advantages for interventional cardiology: System-wide computerization means that medical records are available whenever the physician needs them; EMRs contain complete data on the patient's medical history, diagnostic tests, and treatments; and, unlike handwriting, EMRs are always legible.

An EMR has other strengths too. It enables the creation of templates, so that reports on diagnostic studies or interventional treatments can be completed easily, accurately, and immediately--without the delays of dictation, transcription, or filing. Electronic records can issue reminders to physicians about recommended medications, drug–drug interactions, follow-up exams, and prevention guidelines.

In addition, information from EMRs can flow automatically to and from databases, where it can be used to measure quality of care and to compare one healthcare institution--or one interventionalist--to another. These data can also be used to adjust for patient health and the complexity of each procedure when tracking clinical outcomes. Finally, electronic records can improve research studies by making data collection easier and faster.

"I see the electronic medical record involved in everything we do, from recording images and data, to describing why we did a procedure and what we learned, to analyzing data for quality, to keeping track of the supplies we used and what we need," Dr. Morrison said. "The potential of the electronic medical record to improve health care is huge."

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Headquartered in Bethesda, Md., the Society for Cardiovascular Angiography and Interventions is a 3,400-member professional organization representing invasive and interventional cardiologists. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI was organized in 1976 under the guidance of Drs. F. Mason Sones and Melvin P. Judkins. The first SCAI Annual Scientific Sessions were held in Chicago in 1978.


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