EMR goal should go beyond practice aid to extensive tool for patient care

Regarding "Should I buy my EMR now?" (Article, Oct. 11): I enjoyed your timely article about the cautions of electronic medical record adoption. However, the true power of EMRs is not to run my practice, but to allow the establishment of a patient-focused, community-based, longitudinal health record.

We need to raise our sights to recognize the fundamental change in medical record keeping. The record is no longer simply a memory aid for me to remember my last encounter with a patient; it is a tool that reflects the patient's current health state, is owned by the patient and is contributed to by all caregivers. It is a tool that encompasses ordering and resulting, physician-to-physician communication, access to best-practice knowledge bases and patient participation in their care, as well as practice management functionality, scheduling and account management.

The question that practices should be asking is not "Which EMR should I buy?" but "How can I help create a local environment which will allow such a vision?" This involves some surrogate for "community," usually a hospital, to place a stake in the ground declaring a local standard (becoming the "information hotel," analogous to its role as a health care hotel) and facilitating participation in an enterprise utility.

Physicians will adopt this model when it makes their lives "better, faster, easier," becomes the source of patient information and becomes the expected community standard. This model can be made to work, but its broad acceptance requires regulatory change to allow hospitals and physicians to work together.

It requires that the beneficiaries of this change help to finance it (payers, patients, government regulatory/reporting bodies.) It also requires us to overcome concerns about competitive advantage.

We are all in the same business of caring for our community. It's time to recognize that our communities will benefit if we all work together.

Arnold Wagner Jr., MD, Evanston, Ill.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/11/08/edlt1108.htm.