PROs and CONs of electronic medical records

Having entered the world of medicine just prior to the outbreak of electronic health records (EHRs), I have grown to appreciate its benefits and improvements in care, while simultaneously maintaining a respectful fear of its potential pitfalls. The NIH (National Institute of Health) defines an EHR as a “longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting”. Initially regarded by some as the beginning of a ‘big brother takeover’ or ‘government monitoring system’, the EHR has agreeably produced improved quality of care and patient safety. In addition, the availability of clinical data resulted in an explosion of research and changes in evidence-based practices. While many boast of having an EHR and its myriad of benefits, the risks and dangers must always be considered and addressed. I have a few thoughts on electronic medical records, and below are my top three pros and cons. Please note these are my personal thoughts of EHRs in general and are not an evaluation of any particular EHR software. 

Pros. 

1-The biggest benefit of an EHR, in my personal opinion, is the drastic reduction in medication errors. Before implementing computerized physician order entry (CPOE), reading orders from a paper chart was as confusing and difficult as navigating the New York City subway on my first day here. Deciphering between “morphine or magnesium?” or “one milligram or ten milligrams?” could be fatal. By using a computer to enter medications, general orders, or radiology studies, there was a clear understanding of the prescriber’s intent. Many EHRs are programmed with a ‘hard stop’, meaning if certain prescription or order criteria are not met, such as a medication quantity or route of administration, the order cannot be signed and entered into the record. 

2-At times, we can all appreciate a little government oversight to ensure organizations are following standards of practice. EHRs provide more transparency and accountability motivating healthcare organizations to comply with regulatory guidelines. It also makes it easier to investigate errors and perform root cause analysis.    

3-Lastly, as mentioned above, EHRs provide a greater benefit to society by making research easier to facilitate. With a few keystrokes (and permission from an Institutional Review Board), specific clinical data can be obtained and analyzed, helping to answer questions such as the effectiveness of a medication, outcomes of a clinical procedure, or accuracy of a diagnostic test. 

Cons.

1- Perhaps the biggest risk of an electronic health record is the fact that they are ‘electronic’, and therefore risk subjecting its data and information to a hacker or malicious employee. Not only is confidential health information stored on an EHR, but demographic input such as addresses, phone numbers, birthdays, and even social security numbers (kept on file for billing). Users must invest time, money, and manpower to ensure patient privacy is upheld and personal identities are not compromised. 

2-A three ring binder and some charting documents make for an inexpensive paper record. Upgrade all of that into an electronic record, and costs rise significantly. Though companies who create medical charting software claim their product will save healthcare organizations money (and for the most part, they’re correct), it is an expensive capital purchase and can be costly to maintain. Consider that a large hospital organization will need to not only buy the software upfront, but pay for ongoing maintenance, employee training, and possibly new computers. 

3-Finally, one of the most frustrating phrases a healthcare worker may find themselves saying is “the computer won’t let me”. Some of the limitations in the design of EHR software prevent clinician autonomy or the ability to ‘free text’ when an option needed is unavailable. Additionally, the software for most EHRs are not compatible with each other and cannot share information when a patient seeks care from an outside organization. 

Overall, storing information in electronic health records has guided us to a safer and higher quality healthcare system than years before. Organizations must remain vigilant in protecting this information from malicious use. Further work will be handed to the next generation of health care providers who will be challenged with the task of connecting the various EHRs around the country in order to allow a patient’s record to be accessed wherever they find themselves needing care.