Mandatory Electronic Medical Records: The Right Thing to Do?

Dave Hansen, an AMA Medical News reporter, called the other day to ask: Would, could, and should electronic medical records be mandatory? Health Partners, the big Boston Medical Group, he said. Had mandated EMR use.


Peter F. Drucker (1909-2006) was famous for saying, “Doing the right thing is more important than doing things right. Doing the right thing is effectiveness. Doing things right is efficiency. Focus first on effectiveness; then concentrate on efficiency.”


That only 20% of U.S. practitioners have installed electronic medical records may mean doctors are following Drucker’s advice. They’re focusing first on effectiveness, i.e., do EMRs make my practice more effective? rather than on efficiency, i.e., do EMRs make my practice more efficient? They’re watching and waiting for EMRs to mature.


That’s what I conclude from Medical Records Institute survey of 729 doctors in 2006 and 819 in 2007 cited in the November 12 issue of AMA Medical News. When asked, practitioners using EMRs responded:

Advantages, 2006, and 2007

Improved workflow efficiencies, 81.7%, 71.3%

Improved coding and charge capture, 80.0%, 64.2%

Value-based purchasing/P4P, 33.0%, 33.1%

Improved competitiveness, 44.4%, 30.4%

Pressure from government, insurers, 8.9%, 19.9%

Possibility of subsidized purchase, 15.8%, 19.5%


The Medical Record Institute survey also indicates barriers to EMR implementation – cost, return on investment, lack of partner support - are dropping by about 10%.

Surely EMRs’ time has come. But maybe not. Another survey of effectiveness among EMR and non-EMR users says non-EMR users have more effective performance, “EMRs don’t guarantee quality care, a review of 50,000 patient records shows; on 14 of 17 measures, physicians using paper records did equally well as those using EMRs. They even outperformed electronic record users in one area”, AMA Medical News, August 13, 2007).

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Among Medicare officials, health plans, AARP, other medical societies, HIMSS (Health Information Management Systems Society), the Medical Records Institute, politicians, academic health centers, and members of large group practices, the need for EMRs to decrease waste, improve quality and safety, and enhance coordination, is a given.


That practitioners haven’t embraced EMRs frustrates electronic aficionados. Here, in a foreword to The Physician-Computer Conundrum: Get Over It!, M. Michael Shabot, MD, a medical director at Cedar-Sinai Medical Center, UCLA, expresses the frustration,


“What is this conundrum? Simply stated, it is the disconnect between the highly computerized and network world physicians live in and the grossly retarded state of computerization in most hospitals and health care settings where physicians live and work. Almost all physicians engage in technically complicated electronic transactions in their everyday life, like paying for gasoline at a pump or ordering goods over the Internet, but few enter medical records into a computer.”


And here’s Jonathon Cohn, writing in The New Republic, on November 12.

“ Several European countries are way ahead of us when it comes to establishing electronic medical records. It's the single easiest way to prevent medication errors--a true innovation. Thousands of Americans die because of such errors every year, yet the private sector has neither the will nor, really, the way to fix this problem.”


Should EMRs be mandatory? It’s a hot topic. In its November 12-14 meeting in Hawaii, one resolution before the House of Delegates is : “Do you agree the AMA should seek a full refundable federal tax credit or equivalent financial mechanism to indemnify physician practices for the cost of purchasing and implementing electronic medical records?”

If government wants a national EMR system so badly, perhaps it should pay for universal EMRs, maybe by subsidizing a program analogous to the Hill-Burton Act of 1946. That would be doing the right thing, even if it’s not yet determined to be the right thing to do.

Just because computer can do something doesn’t make it the right thing to do in all circumstances. Universal EMRs may be doing the right thing. They may even increase efficiency. Whether they are more effective in enhancing quality and safety remains moot.

Just because practitioners don’t embrace EMRs doesn’t mean doctors are antediluvian. It may mean doctors want to protect their autonomy and their patients’ privacy; don’t believe EMRs are ready for prime time; don’t feel EMRs are end user-friendly; feel computers in the room negatively impact chemistry of the doctor-patient relationship; regard pen and paper as more effective than mouse and screen. EMR adoption is in transition. It may take 10 years to get from here to there to find what’s the right thing to do.