What do you think of when you think of electronic medical records (EMRs)? Your answer would almost certainly depend to a surprising degree on whether you already have experience with an EMR system. The fact is that EMRs have the potential to transform practice so thoroughly that it’s hard to see them from the front, so to speak.

Part of the problem is the name itself. “Electronic medical records” suggests computerized charts, nothing more. Recently, I’ve heard more than one knowledgeable physician complain about the name — precisely because it suggests that an EMR system will help you do what you’re doing with your paper charts, but on the computer.

The problem with this image is that, like most computer applications, EMRs don’t exactly help you do what you’re doing now; they allow you to do something similar, though, and in a way that makes it possible to do other things. To put it another way —a way you’re sure to be familiar with in other parts of your life — computers don’t simplify work; they enable you to do more complex work.

Computerizing the checkbook

To take a nonmedical example, consider the checkbook. When personal computers were in their infancy, the computer enthusiast’s answer to someone who asked, “What on earth would you do with that thing?” was likely to be, “Well, at least I can balance my checkbook with it.” True enough, but as any Quicken user of today can tell you, the computer version of balancing a checkbook turns out to include writing checks on the computer, paying bills electronically, tracking investment portfolios, evaluating deals on mortgage refinancing, planning for retirement, downloading credit card statements and on and on.

If that’s the computer equivalent of balancing a checkbook, what is the computer equivalent of maintaining a patient chart? I think even current EMR users are just beginning to find that out, and I’m sure it will continue to evolve over the next few years. It can include generating diagnosis and procedure codes automatically, reminding the physician of recommended preventive care services, checking prescriptions against interactions and formularies, customizing patient handouts, automating follow-up with patients by e-mail and much more — not to mention turning the chart room into more productive space.

One eye-opening suggestion of the difference between paper charts and an EMR system I heard recently was a comment made by Brent James, MD, Mstat, executive director of the Intermountain Health Care Institute for Health Care Delivery Research, who observed that EMRs are basically tools for implementing clinical protocols. This may seem somewhat hyperbolic at first glance, but I’m not sure. In his experience, a paper-based office could put no more than four protocols into practice before being buried in a blizzard of paperwork, but computerized records made the process of improving quality of care much easier. In fact, according to James, his group was never able to cost-justify EMRs until they factored in their value in quality improvement.

Unless you’re leaving practice soon, chances are excellent that you will be using an EMR system someday, and probably sooner than you think. And if you already balance your checkbook with Quicken or a similar program, that’s how it will feel — part amazingly easy, part frustrating and part confusing, but hard to do without. If you are already thinking of “computerizing your charts,” I hope you find this issue’s cover story helpful (see page 45). It should give you some sense of where EMRs are today and maybe help you narrow the field.

How ready are you?

If you just aren’t ready for an EMR system — or don’t see how you can afford it — don’t worry. There’s no great rush, at least not yet. For the moment, only a small percentage of physicians have made the move, so you aren’t behind the curve. Just don’t expect to see your paper charts somehow perform less and less well until finally they’re so bad you’re forced to make the move. They will continue doing what they do now and doing it just as well. Eventually, though, you will notice that what they’re doing now isn’t enough or that relying on them to satisfy increasing information needs will get too expensive in staff time and money.

Finally, if you’re just curious to know how you compare with your colleagues in terms of readiness to make the leap, watch for the February issue of FPM and your chance to take the “FPM Practice Self-Test,” which should help you get a sense of how your practice compares to others in a wide variety of ways, including this one. Besides, it’s a whole new millennium; isn’t it time for a check-up?