Doctors need to take a leading role on electronic medical records

With so many heavy hitters in government -- starting with President Bush -- pushing for their use, the question of physicians' adoption of electronic medical records is not if, but when.

But before there's a when, there are a few key hows that need to be answered. Before EMRs are in every office, doctors need to know how to make a standardized technological platform, how to make sure records are secure, and how to make sure the costs don't completely fall on physicians as yet another unfunded mandate.

Perhaps the most important how is the how of ensuring that the physician's voice is heard in the process of answering those questions, creating EMR systems that will allow the gains in patient safety, efficiency and cost savings that advocates say can be achieved. Recently, the AMA's House of Delegates took actions that reaffirmed the organization's active involvement in EMRs, making sure the answer to that how is by bringing the collective voice of America's physicians to the discussion that will end up transforming the way physicians conduct their work.

Right now, various surveys show that some 10% of American physicians use EMRs, and that few of those physicians have systems that allow them to exchange information with a physician using a different system.

It used to be said the problem was that physicians were technophobic, but the reasons for staying with paper have little to do with being a Luddite.

Delegates at June's AMA Annual Meeting, during a hearing on resolutions related to EMRs, spoke of looking at systems that appeared to do similar things, yet cost anywhere from $30,000 to $70,000 per physician, not including licensing and support fees that continue to be paid long after the initial purchase. Also, there were worries about how quickly those systems could become obsolete, and the inability to transfer an EMR to a colleague that has an EMR with a different software platform.

There are various proposals to address these problems while accelerating the pace at which physicians adopt EMRs.

President Bush said in April that he had a goal of getting a personal, portable EMR for every patient in 10 years, while Sens. Edward Kennedy (D, Mass.) and Hillary Clinton (D, N.Y.) also have proposed bills that would require developing EMR standards.

The AMA itself has long been involved with attempts to create a standardized EMR through HL7, a health technology group commissioned by the Institute of Medicine to create such a record. A draft standard has been approved and will be tested for the next two years.

In all of these efforts, there's still the question of whether EMRs would be mandated and if physicians would be expected to foot the bill themselves for a system.

That's why the AMA House of Delegates passed a resolution directing the AMA to continue to assert its role in the conversations over EMRs. The resolution directed the AMA to encourage setting health care information technology standards that would allow different products to be interoperable, yet also would allow software companies to develop competitive systems.

It also directs the AMA to work with Congress and insurance companies to "appropriately align incentives" as part of the development of the National Health Information Infrastructure -- a public-private initiative to create an interoperable health network. Finally, it asks the AMA to review security, standardization and cost issues when participating or commenting on initiatives related to NHII.

The AMA itself is not in the business of setting EMR standards. Instead, its mission is to work together with others to ensure a system that works for all. By making sure the physicians' voice is included, the AMA is ensuring that the question of how physicians adjust to EMRs won't be so hard to answer.