A Challenging Transition from Paper to Digital

For most physicians and patients, today’s office visit is quite different than it used to be. Gone are the days of doctors leafing through folders bulging with reams of papers detailing a patient’s medical history. The digital age has reached the doctor’s office with the advent of electronic medical records.
Stimulated by government subsidy and regulation, the electronic medical record (EMR) has been one of the most rapid and widespread advances of information technology in medicine. More than 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians in Massachusetts now use some form of EMR, and while most physicians agree this technology offers great promise, the introduction and use of EMRs have tested both physicians and patients.
For the physician, the transition from paper to digital has been challenging, especially for small medical practices. While the startup expense can be significant, the impact on workflow in the office can be just as consequential. Most physicians and their staffs have not been trained in information technology prior to the introduction of the technology into their offices. As a result, the physician and office staff must acquire new and different skills to use these systems and integrate the technology into the unique workflow of a medical office.
The learning curve can be formidable, requiring hours of training. Gaining proficiency with EMRs requires much more than just familiarity with a computer. These systems use sophisticated software programs, and the myriad of functions that EMRs must perform to help the physician and benefit the patient — the ultimate goals of electronic records — are different from what most computer users think about. And once proficiency is attained, additional hours are needed to transfer patient information from the paper record to a digital format.
Several factors add to the challenges of physicians using EMRs. The EMRs of a medical practice with a single physician, for example, can be quite different from those of a large hospital or other medical facility. Further, a need exists for standardization among systems: some EMRs are unable to ‘talk’ to one another, hindering the exchange of patient information among physicians and medical facilities — an important consideration when a patient is referred or is seeing multiple doctors.
Patients have concerns as well. A physician’s attention during the office visit may appear to be focused less on the patient and more on the computer and keying in information, thereby taking precious time away from a discussion of medical issues between doctor and patient — and annoying the patient. Confidentiality and security of electronic records are also major issues, particularly as reports appear about the breach of patient records, resulting in the potential theft of medical information.
Physicians are quickly adapting to the digital age, however, and they recognize that the benefits of EMRs can be substantial. Records are retrieved quickly, take up far less space in the office, are almost never lost, and are easily backed up. And, besides storing clinical data on individual patients, EMRs can help to measure the quality of care for an individual patient, perform research, and gather information on the patient population as a whole.
For patients, EMRs present a way to participate in their own care. Through a secure patient portal, individuals can have quick and easy access to records. They can track important data, such as medications, vaccinations, blood pressure, and cholesterol readings; update and correct misinformation if needed; and share the data with other healthcare providers when necessary. These advantages also exist for those authorized and entrusted to care for others, such as elderly or disabled patients.
To those patients concerned that the doctor is paying more attention to the computer than to you during the office visit, our advice is simple: speak up and let the doctor know directly about your concern. Most will understand. As for the confidentiality and security of data, federal laws strictly govern the confidentiality of patient medical information, and EMR systems incorporate layers of protection and continue to update security measures to ensure a high degree of safekeeping.
As physicians with years of experience with EMRs, we encourage patients to ask questions of their physicians to learn more about their records and how they can access them. Electronic medical records can help the physician improve care and help the patient become more informed. That’s a formula for a good patient-physician relationship and better healthcare. For more information and a video discussion about EMRs, visit www.physicianfocus.org/emr.

Dr. Glenn Tucker is chief medical information officer and chief of Internal Medicine at Sturdy Memorial Hospital in Attleboro, and chair of the Mass. Medical Society’s (MMS) committee on information technology. Dr. Joseph Heyman is chief medical information officer at Wellport Health Information Exchange in Newburyport and also a member of the MMS committee on information technology. This article is a public service of the Mass. Medical Society.