More Support for Electronic Medical Recordkeeping

December 12, 2010

Patients: There's more good news about electronic medical recordkeeping (EMR), the digitalized system that records, analyzes and tracks a vast array of medical and hospital processes. A recent Pfizer-sponsored study finds that when patients suffer adverse events from prescription drugs, EMRs may report the mishaps faster and more accurately than when they use existing methods.

Some observers suspect, however, that the new technology may turn out to be more hype than help.

For one thing, the study sample was both tiny -- 26 Boston physicians -- and brief, covering their activities over only a five-month span. The Wall Street Journal reported the methodology: "When one of the doctors in the study recorded discontinuing a medicine because a patient experienced an adverse event, the hospital's electronic patient record system generated an alert." (The term adverse event refers to harm done to a patient from incompetent or inadequate medical care , such as an infection or a drug overdose.) "The system asked the doctor whether the side effect was serious and submitted a report to regulators."

Those findings may be questionable because during the study the physicians reported 217 side effects, but during the previous year they had reported none at all -- a record that raises eyebrows among health professionals. Moreover, of those side effects, only about 20 percent were deemed serious, a rate so low as to arouse skepticism. (A spokesperson for the study acknowledged that some "jiggering" may be required for greater accuracy.) And finally, there is the "cry wolf" element. EMR units sound so many false alarms, say doctors who use them, that credibility dwindles and alerts are ignored.

Proponents of EMR tout it as a remedy for virtually everything, from bad handwriting to vital-signs monitoring -- and this may be so. But the financial outlays are huge: tens of millions of dollars per health system just for equipment and design, plus months of staff training, personnel reassignments and other major changes. The benefits of EMR will ultimately be worth the costs, but along the way there are grounds for a healthy debate.

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