Now for the Opposite Argument

This past Wednesday when I was at San Jose, I continued to record patient names and clinic card numbers from old files as I did last week. Again, I encountered the same issues that would lead me to highly favor a universal switch to electronic medical records, however, during this blog I want to consider some of the downsides to EMR as well. It may seem, at first, that there are no downsides especially considering all of the confusion and how computers can substantially ameliorate it. However, a physician that I have shadowed for a quite a while seems to be adamant against a switch because he believes that it will make private patient files extremely vulnerable to Internet hackers and contribute to the already rampant identity theft. Despite assurances about safety and security of electronic records you can never be certain--furthermore, what are you supposed to do if there is a power outage, or the electronic files are inadvertently deleted? When I was in high school and used to shadow physicians in the primary care clinics of the VA, I witnessed an EMR system first hand. At my interview for A&M, my interviewer mentioned that the Scott and White Health care System has been using EMR since 1989--the year I was born! I communicated to him my experience with the system at the VA, and that the only drawback that was very blatant to me was the fact that the doctors and nurses must type into the computer in order to chart, with their backs toward the patient. Not only does this create an off-putting environment in terms of a health care worker and patient relationship, but also, everything that the HCW is entering into the patient chart is clearly displayed on the computer screen for all in the room to see. Because my dad (an optometrist) has implemented the following in his own clinic, I offered the following suggestion: that instead of desktop PCs, patient files should be accessed via tablet PCs or even iPads. As soon as I said this, my interviewer agreed that they have witnessed the same problem with the backs turned to patients so they have re-oriented exam rooms as a result, and the next step is indeed to purchase tablet PCs. I was excited to see the progress that they have made from the last 21 years in utilizing EMR. Therefore, I suppose this is not necessarily "a case against EMR," rather a consideration of possible improvements to make it more palatable and feasible to be applied in the real life health care setting.