EMR—Electronic Medical Records

Paula LabrotBy Paula Labrot

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EMR—Electronic Medical Records
Remember when the wall behind the doctor’s office receptionist was lined with paper charts? Yours was filed there with everyone else’s medical records until pulled for your visit to your physician. Your doctor’s notes and the reports from other consulting physicians were all in that chart. It was a very different way of practicing medicine. Your doctor was like an orchestra conductor, interfacing with specialists on your behalf. If you went to the hospital, your primary doctor rounded on you every day and coordinated your care with other doctors and hospital staff. Someone who “knew” you was fronting for you. Enter the digital age and the advent of the EMR…Electronic Medical Record! Things have changed! You need a new understanding of your medical “chart.” According to the University of South Florida Morsani College of Medicine, “EMR stands for Electronic Medical Record, which are the digital equivalent of paper records, or charts at a clinician’s office. EMRs typically contain general information such as treatment and medical history about a patient as it is collected by the individual medical practice.” It is a digital record of all your health information. “…Health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations—such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics—so they contain information from all clinicians involved in a patient’s care,” according to HealthIT.gov. PROS OF EMR Electronic medical records give quick, universal access to providers from any point of care connected to the internet. There is definitely an enhanced quality of care based on the availability of medical information about the patient. All diagnoses, treatments and medications are at the fingertips of the attending medical providers, who can make faster diagnoses and more efficient treatment plans. According to Registerednursing.com, “Computerized physician ordering has helped reduce errors related to misinterpreted handwriting and transcription errors. EMRs often have flags or hard stops if an order is entered incorrectly (i.e., the wrong dose ordered, or a med ordered that is listed as an allergy). Electronic medication records assist staff in correct medication administration. In hospitals, barcode scanning, for example, helps correctly identify the right patient, right time, and the right med. Additionally, abnormal results are flagged to prevent them from being overlooked.” Also, patients do not get double prescriptions, and patients cannot doctor shop and get multiple narcotic prescriptions. Accessibility and privacy are considered other benefits of electronic medical records. Paper records are handled by a lot of people setting them up, transporting them to the exam rooms, sending them out to other providers, losing or destroying or abandoning charts to some warehouse when a practice downsizes or closes. (Note: You are, by law, not required to put your social security number or driver’s license number on the initial sign-in sheet, and I recommend you do not!) Another cool feature is that you can see who has accessed your medical record and anyone who signs into them is recorded. Finally, patients have access through their “MyChart-type” Patient Portals to their medical records, alerts to upcoming appointments, test results that have abnormal results flagged and direct message access to their physician.
Universally accessible medical records have some downsides. First, the software is expensive and requires extensive training to use. Technical difficulties can and do cripple whole systems, making any patient information unavailable and requiring paper chart backups that then have to be transposed into the digital system, leaving lots of opening for errors.

EMRs can be very efficient for uncomplicated patient interactions, but, if you are a specialist like my husband, who treats complicated patients with multiple system ailments, the EMR programs can be “over-standardized.” People are as unique and individual as snowflakes.

“It’s frustrating for providers when they need to order something that has not been inputted into the system. Lesser-used medications or treatments may not be part of the selection process,” according to Amanda Bucceri Androus, RN, writing for Registerednursing.org.

Androus addresses the number one complaint with electronic medical records: “Less patient interaction: This is a significant complaint among both patients and providers. Patients see their healthcare provider staring at a computer screen more than they lay eyes on them, which leads to a perception of de-personalization in care. Providers often feel that they spend more time documenting than caring for patients.

Finally, the issue of privacy. EMR’s have their own problems, just as paper charts do. EMR’s can be hacked. Despite stringent medical privacy regulations, electronic charts are vulnerable, and large companies like Amazon, who are about to launch themselves into health care delivery, can’t wait to get their hands on them to, once again, make you the product and sell your information to marketers, insurance companies, potential employers, etc.

EMRs have not lightened a physician’s work load. Quite the contrary. The EMR platforms are not patient centered. It’s a lot of clicks for physicians to sift through a patient’s records, and many physicians either rush that or don’t do it. The platforms are insurance, billing, and legal documentation centered. Physicians are forced to see fewer patients and spend more time as data entry clerks than actually seeing, touching, and connecting with patients. EMRs are the number one cause of doctor burnout.

EMRs are here to stay. Health care delivery is undergoing a sweeping change. Continuity of care is very much in decline, despite EMRs. In the old days, your doctor would round on you every day in hospital and coordinate the care of specialists he or she called in. Someone who knew you in all your beautiful individuality brought continuity to your care. Today, you are turned over to hospitalists, who work from data, to help you get better. They can be good doctors, but they don’t know you, and continuity of care suffers.

It has become clear that seniors are most at risk in hospitals today, often just categorized as “old” and their complaints not worth a big fight. Seniors find lot of strangers deciding “it’s their time.”

Sometimes, I think the patients we see in Floating Doctors on the faraway islands get a better exam from our doctors, who don’t have all the new electronic stuff, but rely on good, clinical skills and have such heart for the patients. We are developing our own EMR platform, soon to be an open source offering to international NGOs, that is very patient-centered, does not contain a single feature related to billing or defensive practice, and will be really easy to use.


EMRs are the present and future of medicine. Knowing that progress mostly lies outside our comfort zones, learn to use your EMR Patient Portals. Be proactive during an exam. Make sure your doctor is
examining you. Make a list of questions you have so you don’t forget them. Don’t go to hospital without an advocate! You need that more than ever today. I don’t like seeing people needing help while staff is busy “inputting” on the computer.

As Socrates said, “The secret of change is to focus all your energy, not on fighting the old, but on building the new.”

Always remember: it’s the Medical Arts, not the Medical Business.
Vamos a ver!
Paula Labrot

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April 30, 2021

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