Electronic Medical Records, Limits of Technology -EMRs and PHRs Don't Impress Doctors and Patients

Something’s going on out there in the electronic medical world, and the “experts,” government and commercial cyber pushers, don’t know what to make of it or what do about it.


Doctors and patients aren’t flocking to EMRs (electronic medical records) and PHRs (patient health records) as the be-all, do-all, and end-all to eliminate medical errors, coordinate care, and streamline care.


It’s not for lack of trying. There are as least 300 EMR vendors are there, and more than PHR systems are available. And yet only 10% of solo physicians, and 20% of all doctors have installed EMRs, and only 5% of doctors and patients are using PHRs. This is even in face of the fact that the Veterans Administration has a system-wide EMR, and Kaiser has both an EMR, available to its 12,000 doctors, and a PHR, My Health Record, available to 8.7 million Kaiser members.


What’s the hang up? Personally, I don’t hanker to go to a doctor to have my problems documented. There are certain personal things I want to keep personal. I want the doctor to pay attention to me, not to the computer. To me documenting isn’t the same as doctoring. As David Pallestrant, MD, founder of Sermo, commented to me, “Having a computer in the room changes the chemistry of the doctor-patient relationship.” And as one VA patient said to me, “ I hate to go the VA. The doctor is always sitting behind that damn computer.” To have a personal record of the encounter is not sufficient incentive to me. Even Gary Baldwin, the technological advisor of Healthleadersmedia and an ardent EHR supporter, admits that his doctor having an EMR is not a sufficient reason to switch doctors.

So what are the experts to do? Michael Leavitt, secretary of HHS, is resorting to veiled threats. In a recent statement, he said he was inclined to proceed with the 10.1% Medicare payment cut unless doctors installed EMRs. This “or else” comment has the sound of childish playground threat and certainly doesn’t speak to the maturity of Mr. Leavitt.

Doesn’t Mr. Leavitt know,

Only 1/10 to 1/5 of doctors have installed EMRs despite 5 years of government and health plan pressure.

EMRs costs $20,000 to $40,000 per doctor to install, and primary care physicians are already trying to make ends meet.


Current evidence indicate EMR users are not less error prone, quality-enhanced, or productive than non-EMR users.

Most doctors see no tangible return on investment form EMR-use.

Meanwhile on the PHR front, vendors are reaching out to health plans and employers to make PHRs more attractive. They’re expanding the data base to make PHRs more useful to doctors.

But privacy, security, and personal obstacles remain. PHRs have advantages for patients with active conditions requiring transfer from one doctor to another, but they have yet to catch on among doctors because of their costs, negative impact on work flow, and expense to maintain, and among patient, who remain concerned about privacy issues. Going to a doctor is not the same as a routine retail transaction, either for the doctor or the patient.

1. Kevin Freking,"Leavitt: Doctors Need Electronic Records, Associated Press, December 3, 2007.

2. Pamela Lewis Dolan, "Pretty Half-Hearted Reception, " American Medical News, December 3, 2007