Electronic medical records
Ideas for improving health care in Canada
Terry Wuerz Volunteer Staff
Imagine for a moment that the mayor of New Jersey commissions a bridge to be built over Brooklyn.
It does not particularly matter why he is building this bridge, but for the sake of the story let’s say it is because his residents are sick of all the traffic in New York and desire a more rapid route to Rhode Island. I have never been there, but what I understand from watching Jersey Girl is that New Jerseyans are characteristically enraged over the amount of time spent in city traffic.
So, the mayor hand-picks a well-qualified engineer who sets out to plan his grandiose project. His team works overtime for months to ensure that everything is laid out perfectly. He, of course, makes sure to pay very close attention to all the exacting and persistent details. Construction, at long last, is finally about to begin, when the mayor is replaced by a successor, who decides to fire the engineer in charge of this super-project.
Staying within our fantasy realm of big politics and even bigger bridges, consider the consequences when the new engineer and his team are not able to view the records or to consult with any of their predecessors. All the work that was done up until that point would be forfeited; tens of thousands of dollars as well as several months would be lost. A nightmare of inefficiency, this situation can largely be prevented with a good system of recording and exchanging of professional data.
This is exactly the terror that exists, on a much smaller scale, every day in a majority of clinics and hospitals in the medical world.
Every health professional that sees a patient is obliged to maintain a record of their findings, diagnoses, and treatments that have come up throughout the course of care for that person. This record serves multiple purposes, including legal ones. If a physician offers their patient a particular treatment but does not record this exchange in the patient’s medical record, the law dictates that this exchange did not legally take place. The doctor could be sued for failing to offer a life-saving treatment and would have no way of proving that he or she actually did offer the treatment.
Medical records have the potential to make our health care system tremendously more efficient with the introduction of electronic medical records (EMRs). In doing so, a lot of dollars could be saved. What is more, the quality of care could also stand to benefit, especially regarding chronic diseases, such as diabetes.
To illustrate just how inefficient the system is, consider a doctor working in the emergency department. This is arguably the highest volume, fastest turnover area of medicine. Quick, accurate diagnoses and rapidly devised management plans are the name of the game. There is little time to delve into the intricacies of the past medical diagnoses and treatment plans of some individuals. This is especially true of elderly people or those with a complicated medical history. The time spent going over prior medical illnesses is a waste and can seem redundant to patients. All too often, patients tell different medical professionals the same story.
Such information can be crucial to the here and now of diagnosis and treatment in the ER. If an ER doc had easy access to a patient’s past medical records, those working in the ER could be more efficient and accurate in figuring out what is wrong at the current time and advancing the plot of patient treatment. To look at it another way, they would not have to do the work that has already been done by other medical professionals. This is, of course, the point.
Benefits of an electronic medical database extend beyond efficiency in the ER. Family doctors would be better informed of what is happening to their patients while they are in the hospital. Walk-In Clinics, which are notoriously brief in their doctor-to-patient contacts, stand to benefit immensely. Miscommunication between health professionals could be avoided in some instances, as could mountains of actual paper.
At the current time, there is no central electronic medical database. However, some clinics and hospitals, as well as some countries, are ahead of others in this area. To date, the largest public administration of EMR is in the UK, where they hope to have 60 million patients with a central EMR by the year 2010. The Health Sciences Centre and Saint Boniface Hospital, the two largest medical institutions in Manitoba, still use paper records. While businesses such as Safeway have fully digitized check stand displays and grocery tracking systems, health care in general lags behind.
One objection to the EMR bandwagon is the threat of Internet piracy. Much in the same way that credit card numbers used over the web have become prey to scams targeted at stealing financial information, the worry over a similar assault on health information is very real.
Nearly every advance in health care is fraught with potential harm. In the end, the risks must be weighed against the benefits. In the case of a central medical electronic record system, the potential to drastically improve the way health care is practiced is undeniable. Certainly, any system that is put into place will need to incorporate the threat of health information theft, and safeguard against it.
To be sure, an engineer taking over a project would want to have a proper transition of records regarding any project. Making it easier for health care professionals to have the same makes sense and would save Canada a lot of money.
The question of whether or not Canadian health care should become more privatized is routinely bandied about in the media. The debate is almost always put forward as a dichotomy: either privatize, or continue to push more public dollars into our system. However, there are other options. There are many ways our current health system could be made more efficient. Digitizing and centralizing our medical records is merely one of them. Before we start taking steps towards a system where some Canadians can pay for better access to health care, we owe it to those who cannot to take a closer look at improving the system we already have.
Terry Wuerz is a third-year medical student.
