2010 Electronic Medical Records and the perception of the patient Julia Ferry HCA 708 12/3/2010
Electronic Medical Records and the Perception of the Patient Table of Contents 1. Introduction 2. What is an EMR? 3. Why are Electronic Medical Records Not Common? 4. What do patients think of EMR systems a. Headache Facility Study i. General Opinion ii. Opinion of Service iii. Access/Efficiency/Reliability iv. Personal Preference b. Technology and Medicine Study c. Other Studies 5. Conclusion Ferry 1
Introduction At one time in our history, computers were as large as a room and reserved for use in industries like NASA. In 2000, computers became a natural fixture in about 51% of American homes (US Department of Congress). Today that number is estimated to be much larger as many more people choose digital content. Digital content is easy to access and travel with; therefore, many people prefer it than the more traditional physical content. For instance, newspaper sales are down 7% in 2009 from the previous year, and in the first quarter of 2009 the internet newspaper websites were up 10.5%, that is 73 million new unique visitors we no longer receive our news through a traditional daily paper but rather a digital one (Arango 2009). Since computer technology is more common and has become cheaper and smaller to produce, many more devices are becoming portable. Cell phones now can access the internet, create documents, send email, share pictures, and video chat with friends and family. People are utilizing technology to become more portable with their information and more productive with their time. It is possible to store thousands of documents and books with-in the size of a portable hard drive, often less than 2.5 inches by 3 inches, and this data can be accessed from virtually anywhere. But not every industry has gone digital. The medical industry found, in a 2005 national survey, that 37% of the hospitals claimed to have technology in place to support the use of electronic medical records, or EMRs (Glandon 2008). In other words, 37% have the capability of going to digital content and 63% are not even capable of making that transition. The medical industry is behind in the digital trend. Ferry 2
What is an EMR? A patient s health record is a collection of the medical information that pertains to that patient from the routine office visit to services performed on them. These records are used for reference in the event of future illness, as well as a record for insurance companies. A patient s health history can provide insight for future diagnosis or possible reactions to past medications. It is a vital part of the medical system. These charts could be papers compiled over the years and two hole punched into a patient folder for keeping on the doctor s shelf or it could be virtually stored patient information and data accessed digitally for quick reference in the patient s room. When the chart is digital content it is considered an EMR, or electric medical record. Currently, there is no universal standard to data inscription of the EMR charts. If there were a universal standard, patients could take their charts from any physician across departments and medical facilities. This way, your medical record could be accessed for reference from anywhere that you are. If you had a medical emergency while traveling, your medical record would be accessible almost instantly for medical history reference as opposed to waiting several hours or days for it to be faxed from your family practitioner. Why are electronic medical records not common? Why, in a world of digital content, is the medical industry behind by still using paper charts? This is a question of cost verse benefit ratios. There are many considerations that medical facilities must make in deciding if an EMR is right for them because there are many organizations that have created templates from patient intake Ferry 3
forms to compilation of the patient s tests. These templates offer different benefits to different facilities and range in various prices. An EMR not only takes labor to transfer the charts that were initially penned but also takes labor to maintain. Facilities might need to invest in new computers for the offices to execute the EMR programs or even servers to be installed and maintained to share the records between nurse and doctor. These are costs that do not have an easily defined benefit and spending money without making money is not exactly a smart business decision. Facilities might assign a value to extending a patient s life with the assumption that the medical charts will decrease physician error. But even with this added benefit, cost might significantly out-weigh it. A facility often needs to contract or actually employee an information technology specialist to maintain the computers, network, and databases for an EMR; this would mean the office incurring an annual fee. What do patients think of EMR systems? Headache Facility Study A study was conducted in a headache specialty practice in Greensboro North Carolina. Most patients of the facility experienced treatment at the center for an average of 4.07 years (Freeman 2007). In 2002, the facility implemented an electronic medical record in the office and in 2006 they had a total of 394 patients use a 5- point Likert scale to rate 15 different statements. Of those surveyed 83% used a computer daily while 94% said they owned a computer (Freeman 2007). Responses for all statements trended in favor of their EMR. The statements were classed as statements around service, access-efficiency-reliability, personal preference, and general opinion. Ferry 4
General Opinion General opinion of the EMR ranged from favorable to no opinion. When asked if the computer system less friendly than the paper-based office, the majority of patients strongly disagreed or disagreed that it was less friendly and, in contrast, only 7.1% felt that it was less friendly. Of those surveyed, 12.5% said that they were not receiving better medical care because of the computer, where-as, 40.5% felt that they were. When asked if they had more confidence in an office using computer medical records, 49.7% answered that they strongly agreed or agreed. A large majority (66.9%) of those surveyed also agreed or strongly agreed that they were pleased that the office was using a computerized medical record system. Opinion of Service Opinions of service did not decrease with the introduction of an EMR. When asked if they felt like the computer came between them and the provider, 78.8% either disagreed or strongly disagreed with the statement and 15.3 had no opinion on the statement. When asked if the eye contact with the provider was less due to computer use, 15.8% of patients said they had no opinion and 69.6% they strongly disagreed or disagreed with that statement. Only 6.7% of patients said their visit felt longer due to the use of the computer system. Access/Efficiency/Reliability When patients were asked statements that dealt with access, efficiency, and reliability, the majority of the replies indicate that EMRs make the medical office, more efficient and reliable with more access to medical information. Patients responded very Ferry 5
positively with 76.5% indicating a strongly agree or agree statement when asked if medical information is easier to access with computerized medical records. When asked if less error were made with computerized medical records, 10% said they disagree or strongly disagree. In other words, a very small percent (10%) of the patients felt that the medical records did not improve the quality of care. When asked if the medical record confidentiality was improved by an EMR, 50.3% stated they had no opinion. When asked if they felt the medical office was more efficient by using an EMR, 58.4 either strongly agreed or agreed that it was more efficient. Personal Preference of EMR Personal preference statements indicate that patients just prefer an electronic version of their medical record in office. When asked if patients felt that computer generated prescriptions were better, 63.3% felt that they did and 62% had no opinion on if the pharmacy preferred computer generated prescriptions. When asked simply if patients preferred the EMR office only 6.6% said they did not, suggesting a strong preference among patients for an EMR. Technology and Medicine study A different study done surveyed patient s opinions on conversions from paper records to EMRs and the results indicate that patients are looking for electronic changes in medicine. Stephen Downs said this, This is the age of the iphone, Facebook and Google Maps, yet healthcare feels very much the same. This study suggests that people are ready for change they want a modern healthcare experience." The study asked several questions of patients from Boston, Portland, and Florida, and found that Ferry 6
patients would be willing to rely on computer protocols and faceless doctors for minor complaints (Merrill 2009). In other words, patients would not mind having computers do the treating and diagnosing for the more common ailments and save the doctors for the more critical issues. These faceless doctors would act as coaches that foster self-care. This takes the idea of EMRs to an even more advanced level, one where it supports the movement for patient autonomy. In both studies, patients expressed that they did not care as much about their confidentiality but rather, were looking for improvements to service and access. Other Studies As technology becomes more congruent to more and more lifestyles, the medical industry will look for new ways to stay in contact with their patients. In a study titled: If you build it, will they come? The Kaiser Permante model of online health care, examined that patients will be more likely to use online services, such as obtaining lab tests, scheduling appointments, and doctor patient email if the medical facility offers it. And another study by the same group indicated that e-mail messaging increased six times from 2005 to 2007(Garrido 2009). Technology must not take away from the doctor patient relationship though. A study of an EMR system used by Israeli primary care physicians found that doctors spent close to 42% of their time viewing their computer screen (Margalit 2006). A habit like this could deter patient s positive views of the EMR system and should be a behavior of consideration for physicians using a new EMR to monitor. Ferry 7
Conclusions While EMRs can be expensive, patients seem to have a preference to them; they perceive the electronic version of their medical record as being more accurate, giving doctors more access to medical information. One day this perception might be used in the patient s choice in medical facilities, thus greatly impacting the cost benefit ratio. It is as the technology advances, so does the general use of that technology. And the more we use technology the more we expect others to use it as well like the medical industry. Benefits of electronic records over paper ones are obvious -- everyone has heard the generalization about physician hand writing, and prescriptions with poor handwriting can and often do lead to incorrectly filled medications. And it is problems like these that can be avoided by electronic dictation of these medical records and physician directives. As indicated in the mentioned studies, patients perceive the EMR as a way to improve over-all patient care, making a potential for EMR competition among providers. EMRs might not be commonly used right now, but they are the preference of the patients and perceived positively by them. Previous concerns about confidentiality and privacy seem to warrant much concern anymore, as patients are looking for more technology forward ways to interact with the physician rather than worry about their privacy during those interactions. Who knows, maybe when we are sick, we won t have to leave the comfort of our home to consult the physician. Ferry 8
Reference List: A, Silvestre. Et al. If You Build it, Will They Come? The Kaiser Permanente Model of Online Health Care. Health Affairs. 2009.28(2):334-44 Freeman, Marshall. Et al. Electronic Medical Record System in a Headache Specialty Practice: A Patient Satisfaction Survey. American Headache Society.2007 Margalit, Roter. Et al. Electronic Medical Record Use and Physican-Patient Communication: An Observational Study of Israeli Primary Care Encounters. Patient Educ Couns. 2006;61:134-141 Merrill, Molly. Study Reveals Patients attitudes toward EMR conversion. 2009. Retrieved from: http://www.healthcareitnews.com/news/study-reveals-patients-attitudes-toward-emr-conversion US Department of Congress. 2000. Retrieved from :http://www.allcountries.org/uscensus/914_households_with_computers_and_internet_access.html Yy, Zhou. Et al. Improved Quality at Kaiser Permanente Through Email Between Physicians and Patients. Health Affairs. 2010,29(7):1370-5 Ferry 9