Correspondence
Electronic Health Records in Hospitals
N Engl J Med 2009; 361:421-422July 23, 2009
- Article
To the Editor:
In their study of the use of electronic health records, Jha et al. (April 16 issue)1 report that only 1.5% of U.S. hospitals have comprehensive electronic-records systems, and 7.6% have a basic system that includes a capacity to store physicians' notes and nursing assessments in at least one clinical unit. Interestingly, doctors overwhelmingly say that electronic-records systems improve care,2 a view that is borne out by the Veterans Health Administration (VHA) experience.3 Nevertheless, very few U.S. physicians use electronic health records. The reasons range from cost to the lack of a national standard.2
The VHA already has an excellent system, the Computerized Patient Record System (CPRS), which has been successfully used for the past 10 years to manage the care of approximately 8 million veterans.4 This system is highly reliable, and because it is government shareware, it is available free of charge (www1.va.gov/cprsdemo). The only criticism I have heard about CPRS is that it does not allow for billing, which is something that could be added. CPRS should be made the nationwide standard tomorrow or, better yet, today.
4 ReferencesJosh H. Lipschutz, M.D.
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104
jhlipsch@mail.med. upenn. edu 1
Jha AK ,DesRoches CM ,Campbell EG , et al. Use of electronic health records in U.S. hospitals. N Engl J Med 2009;360:1628-1638
Full Text | Web of Science | Medline2
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 | Medline3
Jha AK ,Perlin JB ,Kizer KW ,Dudley RA . Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med 2003;348:2218-2227
Full Text | Web of Science | Medline4
VA benefits and health care utilization. Washington, DC: Veterans Health Administration, 2008. (Accessed July 6, 2009, at http://www.tecaccess.net/VetAccess/VA%20Benefits%20data_6%2010%2008%20%282%29.pdf.)
To the Editor:
Jha et al. have provided an important incremental advance in our knowledge regarding the use of electronic health records in U.S. hospitals. The authors did not include an anesthesia information management system (AIMS) in their definition of either a comprehensive inpatient electronic health record or a basic electronic record. This is an important omission. An AIMS is the anesthesia component of an inpatient electronic health record.1 As such, it is the electronic record for a high-risk and expensive episode of inpatient clinical care. Approximately 30% of U.S. hospital admissions involve surgical care.2
2 ReferencesJeff T. Mueller, M.D.
Terrence L. Trentman, M.D.
Mayo Clinic Hospital, Phoenix, AZ 85054
mueller.jeff@mayo. edu 1
Egger Halbeis CB ,Epstein RH ,Macario A ,Pearl RG ,Grunwald Z . Adoption of anesthesia information management systems by academic departments in the United States. Anesth Analg 2008;107:1323-1329
CrossRef | Web of Science | Medline2
AHA hospital statistics 2009 edition. Chicago: American Hospital Association and Health Forum, LLC, 2009.
To the Editor:
Jha et al. do not address the question of the preservation of patients' confidential information. As Gillon wrote, “The principle of medical confidentiality is one of the most venerable moral obligations of medical ethics.”1 And years ago, Siegler was “astonished to learn that at least 25 and possibly as many 100 health professionals at our university hospital had access to the patient's record.”2 Will not the adoption of electronic medical records further increase the number of people with access to those charts?
2 ReferencesIvan D. Miziara, M.D., Ph.D.
ABC School of Medicine, 05411-000 Santo André, Brazil
miz@uol.com. br 1
Gillon R . Confidentiality. Br Med J (Clin Res Ed) 1985;291:1634-1636
CrossRef | Web of Science | Medline2
Siegler M . Confidentiality in medicine -- a decrepit concept. N Engl J Med 1982;307:1518-1521
Full Text | Web of Science | Medline
Author/Editor Response
We agree with Lipschutz that most physicians, once they overcome the challenges of adoption, are happy with the use of electronic health records. Furthermore, the system that the VHA uses is an excellent tool. It is clinically intuitive and has all the features necessary to allow clinicians to deliver high-quality care. Whether it is the right solution for every physician and hospital in the United States is less clear. However, given that the system is free and familiar to many clinicians, many providers may see this as an attractive solution.
With respect to the issue raised by Mueller and Trentman about anesthesia information systems: we agree that such systems are likely to be helpful for managing the care of high-risk patients. There are other such “specialized” solutions, including information systems in cardiac suites and operating rooms, which are also likely to be valuable for hospitals. Unfortunately, the scope of our survey limited our ability to examine these areas.
Finally, Miziara expresses concern about privacy, which is on the minds of many clinicians and patients as we transition to the widespread use of electronic health records. In contrast to paper-based records, which are highly insecure, enormous focus has been placed on establishing privacy and security standards for electronic records under the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA). Indeed, as recently as February 2009, Congress further strengthened HIPAA to ensure the privacy of health information.
Ashish K. Jha, M.D., M.P.H.
Boston Veterans Affairs Hospital, Boston, MA 02130
ajha@hsph.harvard. edu Catherine DesRoches, Dr.P.H.
Massachusetts General Hospital, Boston, MA 02114Sara Rosenbaum, J.D.
George Washington University, Washington, DC 20052
