The Electronic Medical Record
Dennis L Hufford, MD
Faculty Development Fellowship
Madigan army Medical Center
(graduate studies research paper)
(accompanies PowerPointÒ presentation)
Edited for web page 14 July 1999
While many industries quickly integrated information management technology into their business processes, the healthcare industry has lagged behind this trend. Despite rapid adoption of other high technology relating to diagnostic and therapeutic technologies, doctors and others within the industry have been reluctant to embrace integrated information management systems. This paper will explore reasons for the tumult surrounding high-tech innovation in medical information management.
Healthcare administrators first recognized the potential for computerized data management in the 1960’s [Waegemann 1998, 4]. The rapidly increasing volume of medical information being generated made computers a logical choice in helping to organize, store and retrieve data. As in many other industries, those responsible for the data input (doctors) often encountered frustration in their ability to interface efficiently and effectively with early computers. From the doctors’ perspective, the benefits of electronic data storage were slow to materialize and hard to recognize. Many were disillusioned interacting with computerized data management systems, and resisted relinquishing traditional pen and paper documentation. Computers became tools used mostly by administrators in an increasingly adversarial relationship with the various health professions. This disharmonious relationship was greatly exaggerated by the managed-care revolution in the United States, when administrators and third party payers developed far greater power over doctors and their practices.
Now far behind many other technology dependent industries in terms of data management, the healthcare industry is slowly beginning to accept the need for a replacement to paper records [Luxford 1995, 89]. Factors influencing this change include: • Frequent failings of conventional health records to capture adequate data to support the documentation needs of third party payers, • Increasing mobility of patients and multidisciplinary care, and • Technological innovations that have made computerized records more practical. This paper identifies and discusses the market needs for an electronic medical record (EMR) [Waegemann 1998, 5]. These needs include: • Capture and storage of all relevant medical data relating to patients as well as populations, • Security and confidentiality of medical information, • Portability of information including access from many different sites, and • Facilitation of quality improvement, research, and cost control programs. Enabling technologies such as networks, the Internet, portable computers, touch-pens, voice recognition and template-based note software, and object technology are reviewed relative to their impact on EMR. EMR’s current position in the technology life cycle is illuminated. Three representative examples of EMR applications are described, illustrating the state-of-the-art and the diverse needs of the industry. Current market forces, movement toward standardization, and the likely future of the industry is presented. My conclusion is that EMR represents a radical innovation in healthcare information management that will continue to grow slowly until such time as enabling technologies within the industry realistically overcome the data entry barrier. Companies that can effectively market the best data input technology will quickly experience rapid growth in keeping with models of the digital economy, including principles of increasing returns and potential market dominance.
Recall the last time that you went to see a doctor for a routine medical problem. Ideally, you received high quality care from your...