Correspondence
Electronic Health Records in Ambulatory Care
N Engl J Med 2008; 359:1848-1849October 23, 2008
- Article
To the Editor:
DesRoches et al. (July 3 issue)1 describe the low level of adoption of electronic health records by primary care physicians in the United States. In contrast, electronic health records have been widely adopted by primary care and hospital trusts of the National Health Service in the United Kingdom. York Hospital is now using electronic resources to improve communication among health care providers by implementing a prompt (<24 hours), accurate, electronic summary of each patient's hospital discharge.
We recently surveyed local primary care physicians about the hospital's “electronic discharge notification”; 50% of the 81 primary care physicians surveyed had received and used it. A total of 80% of these physicians stated that this format was a considerable improvement over the commonly illegible handwritten format, and 95% of them agreed that electronic discharge notifications should include the diagnosis, medications, recommendations for primary care physicians, outpatient follow-up information, and the discharge destination. A total of 90% of these physicians thought that the new electronic summary should continue as the first document of communication with primary care physicians on patient discharge. We believe that with the increased adoption and awareness of electronic discharge formats, communication between hospital physicians and primary care physicians will improve.
1 ReferencesMatthew J. Armstrong, M.B., Ch.B.
Caroline Booth, M.B., Ch.B.
York Hospital, York Y0318HE, United Kingdom
mattyarm@doctors.org. uk 1
DesRoches CM ,Campbell EG ,Rao SR , et al. Electronic health records in ambulatory care -- a national survey of physicians. N Engl J Med 2008;359:50-60
Full Text | Web of Science | Medline
To the Editor:
There are great advantages and disadvantages to the implementation of electronic health records, but the question is how to fund it all. The authors seem to suggest that government-run universal health care and electronic health records are the answer. I disagree.
The federal government's involvement should not stretch beyond establishing basic requirements for an information-technology infrastructure. From state-of-the-art hospitals to community clinics, public and private alike, the federal government should decide on a common language spoken by all, create standards, and provide a timetable for implementation. This will enable a wide and universal networking system to develop, but health care organizations should be the masters, architects, and craftsmen of their own projects. The federal government should have the important task of regulating standards to safeguard privacy and no more. Electronic health records are the way to go, as long as security and privacy issues are resolved.
Irene M. Spinello, M.D., M.B.A.
Kern Medical Center, Bakersfield, CA 93305
spinelloi@kernmedctr.com To the Editor:
Insufficient functionality is a more significant factor in the adoption of electronic health records than the authors imply. The flaws my group has encountered have included failure to support scanning and archiving of documents that have come to our practice from elsewhere, failure of electronic prescribing systems to handle durable medical equipment, and failure to integrate image storage and to generate reports from imaging studies. The electronic-records industry will find more enthusiastic adoption when they ask concerned clinicians about what their software and hardware fails to do properly and when they fix those problems.
Jeffrey L. Kaufman, M.D.
Baystate Vascular Services, Springfield, MA 01107To the Editor:
As a general surgeon, I have a constant flow of new patients and must find and record existing information from any number of sources and send my clinical notes to many destinations. Without semantic interoperability standards to facilitate the transfer of structured documents in Extensible Markup Language (XML), I must rely on the fax machine as my messaging medium. As long as 95% of clinical data comes in and goes out as fax documents, I am locked in a paper world where manually entering data and maintaining my application service provider (ASP) model of electronic health records costs precious additional time. The lack of semantic interoperability was not mentioned as one of the barriers to adoption. Inexpensive ASP options are offered, but they are not promoted by many vendors of electronic health records, and thousands of physicians use them, including me.
James G. Mhyre, M.D.
Proliance Surgeons, Kirkland, WA 98034
j.mhyre@proliancesurgeons. com Author/Editor Response
We agree with the comments about the importance of interoperability standards and their effects on communication between the inpatient and outpatient settings. Interoperability between information from the inpatient setting and the outpatient setting is the holy grail of adoption of electronic health records, and it has the potential to offer tremendous benefits for patient care. However, to date the adoption of interoperable electronic health records is extremely low, and it is difficult even to establish a reliable estimate of the use of such systems.
The Office of the National Coordinator for Health Information Technology has been developing standards for interoperability. Although this is an important effort, such standards will not be sufficient to ensure the widespread adoption of electronic health records by physicians. Given the proportion of physicians in our survey who cited cost as a major barrier to adoption, addressing this issue could have a widespread effect on adoption. Rather than calling for universal health care, we suggest simply that a major financial investment will be necessary to ease the financial burden of adoption of electronic health records by physicians.
Catherine M. DesRoches, Dr.P.H.
David Blumenthal, M.D., M.P.P.
Massachusetts General Hospital, Boston, MA 02114
cdesroches@partners.org - Citing Articles (1)
Citing Articles
1
CARSTEN H. MEYER, HANS-MARTIN HELB, FRANK G. HOLZ. (2010) A COMPUTER-BASED DOCUMENTATION AND DATA MANAGEMENT SYSTEM OF CLINICALLY RELEVANT PARAMETERS DURING REPEATED ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR OR STEROID INJECTIONS. Retina 30:2, 369-377
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