Death is an unavoidable part of life. It can come at almost any time and from almost any source. Even something as simple as a walk down a flight of stairs has the potential to lead to tragedy. Hospitals have generally been seen as man’s last bastion of hope against the specter that is Death. However, just like death, human error is also unavoidable. When these two unavoidable factors come together in a medical institution where salvation is expected, the result is tragedy. Needlessly, thousands of lives have been lost due to simple human mistakes in the very place where the best chance of saving those lives could be found.
Despite the expense and hurdles of implementation, the establishment of an Electronic Medical Record (EMR) infrastructure is an essential key to saving lives and money over the long term. Admittedly, putting an interconnected network of EMR systems throughout a country is a daunting prospect and will be time-consuming and expensive. Getting a single facility to make the switchover from standard physical records would be a challenge. The cost of purchasing the required equipment, providing training for staff and the long task of converting existing records into an electronic format have given most medical facilities reason for pause.
In addition, with this technology there are associated privacy concerns. As one Director of Information Systems by the name of Lincoln Stein outlined in a paper (Stein, 1997), these concerns are over the possibility of the system being ‘hacked’ into or even legitimate access being abused by inquisitive personnel. These crucial issues have to be addressed from the outset of the design of any such system. However, they are not insurmountable and careful forethought and security restrictions the EMR system can be protected and considered safe. The potential good of its implementation outweighs with the potential bad.
In contrast to the current paper archives, EMR allows for redundancy in the face of calamity. Even something outside of Mother Nature’s arsenal, such as a ruptured water main or a fire can destroy physical records. Catastrophic loss is avoidable with EMR because they are capable of being easily backed-up, ideally to a remote location or another facility. The Cadence Group examined this issue using the event of Hurricane Katrina where medical, business and even legal records were destroyed by the flooding but electronic records that had backups were saved (Cadence Group, 2005).
The net result is a far more robust system that can allow remarkable resilience, even in the face of extreme situations. Next, one of the immediate advantages would be improved safety and overall efficiency of a patient’s journey through the medical system. In the current paper-based system charts are misfiled, pages lost, files misplaced, and an unfortunately situated cup of coffee (or urine specimen), can wipe out a patient’s entire medical history. There is also the infamous illegibility of doctors’ handwriting, which can render important medical information inaccessible.
Mistakes during transcription can be propagated throughout the written record. Sometimes consequences of such mistakes are mild: a form has to be filled out again or a quick test has to be repeated. In tragic scenarios, the outcomes of those mistakes are life changing: surgeries performed on wrong patients or limbs, expensive and painful tests performed repeatedly and in the worst case: death. The Time magazine published an article citing a 2006 Institute of Medicine study which indicated that over 7000 deaths were on account of unreadable handwriting (Caplan, 2007).
A direct consequence of the improved reliability and efficiency is the promise of tremendous savings in financial terms. The advent of a widespread, interoperable EMR system has the potential to save over 160 billion dollars annually in the United States alone (Hillestad et al. , 2005). EMR can practically eliminate costs for space and equipment, such as filing cabinets, to store patient records. It will help generate accurate billing information. Handling patients will be a faster and more accurate process since all test results and patient history will be accessible much faster.
Iatrogenic deaths, deaths unintentionally caused by health care personnel or procedures, cost close to 300 billion dollars (Figure 1) according to a team of researchers (Null, 2010). The savings estimated in that paper did not even factor in some factors such as reduced malpractice lawsuits and insurance. EMR definitely holds the capacity to have a very positive return on investment. Additionally, EMR can reduce the instances of adverse drug events (ADEs). The attending staff must not only remember to administer the correct drug but also at the right time and in the right dosage.
In some instances, patients require a myriad of drugs, some of which can have negative reactions with each other. A relatively recent study analyzed adverse drug events in hospitalized patients over a 30-year span and concluded that it was between the sixth and fourth leading cause of death (Lazarou, 1998). This is an excellent example of how EHR can come to the rescue. Whereas human memory might fail to recall the appropriate time to treat a patient or might supply faulty information regarding the dosage, the electronic system stands vigilant.
It will indicate if a drug is safe to give to the patient, the time it should be done and record the details of a treatment for audit purposes. Clearly, the EHR can enhance patient safety and improve chances of survival by reducing adverse drug events during the hospitalization of patients. Implementation of EMR can be instrumental in disease management, especially chronic ones (Hillestad et al. , 2005). First, analysis software can screen patients via their various test results and identify those most at risk of certain chronic diseases.
Second, the EMR system can keep track of treatments, which is valuable information for health care personnel. Third, by recording the response rate for trial medications during clinical tests, the EMR can expedite the return of results. Fourth, with properly implemented EMR the flow of patient treatment is optimized by improved communication between various departments and specialists. One example is that of Phyllis Hendrickson, a diabetic whose sodium levels put her life in danger (Andrews, 2009). It was solely due to a computer notification of those levels to an on-call doctor, that Mrs.
Hendrickson was contacted and treated. With the combination of preventative intervention, treatment monitoring, feedback from clinical trials and improved relay of information, the EMR infrastructure can help to manage chronic disease, such as diabetes, which is on the rise (Mokdad, 2003). Notably, even the current leader of the most powerful nation on the planet is championing the cause (The WhiteHouse, 2009). Granted, it will take time, money and effort to implement this technology in any country.
To paraphrase the author Hamilton Holt “Nothing worthwhile comes easily”. However, it would be self-injurious to a land to shy away from this technology. One need only ask the surviving relatives of a family member who was lost due to a medical error: “What price can one put on life? ” This constitutes an investment that can help distinguish the health care sector of any country as truly First World. Man may not be master over the elements, time travel may still yet be a dream and death might be an inexorable and unconquerable foe.
What is within man’s grasp however, the ability to mitigate the tragic consequences that might arise from simple mistakes, especially within the realm of healthcare. Reduced errors from poor handwriting, protection of patient data, improved management of chronic diseases and better access to patient history are some of the key ways that electronic medical records will influence the health care system. Their effects can be lessened greatly or eliminated altogether by transitioning to a digital infrastructure. “To err is human” but electronic medical records can save lives.
Andrews, W. (2009). Are electronic medical records the future? Fairfax: CBS Evening News. Cadence Group. (2005, October 25). When disaster strikes, will your vital records be safe? Retrieved April 17, 2010, from Cadence Group | Information Management Staffing, Consulting and Outsourcing Services:: http://www. cadence-group. com/articles/records_management/disasterRecords. htm Caplan, J. (2007, January 15). Cause of death : sloppy doctors. Retrieved April 16, 2010, from Time in partnership with CNN: http://www. time. com/time/health/article/0,8599,1578074,00. tml Hillestad, R. , Bigelow, J. , Bower, A. , Girosi, F. , Meili, R. , & Scoville, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs , 5 (24), 1103-1117. Lazarou, J. P. (1998, April). Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. Journal of American Medical Association , 1200 – 1205. Mokdad, A. H. (2003, January). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.
Journal of American Medical Association , 76-79. Null, G. D. (2010). Death by Medicine. Mount Jackson, VA: Praktikos Books. Stein, L. D. (1997). The Electronic Medical Record: Promises and Threats. World Wide Web Journal , 2 (3), 217-229. The WhiteHouse. (2009, February 24). Remarks of President Barack Obama — Address to Joint Session of Congress | The White House:. Retrieved March 21, 2010, from [Official Website of the White House and President Barack Obama]: http://www. whitehouse. gov/the_press_office/remarks-of-president-barack-obama-address-to-joint-session-of-congress/