EMR: Great opportunity disguised as a threat

A message to all physicians from AMA President William G. Plested III, MD.

By William G. Plested III, MDis a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07. Posted Sept. 25, 2006.

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I feel strongly that American medicine is being handed a once-in-a-lifetime opportunity to reclaim a vital part of our profession, a part that has eroded in the recent past.

The opportunity is the product of the advent of the electronic medical record.

Claims that the EMR will reduce cost of care are overblown drastically in my judgment. But there are other aspects of EMRs that will prove enormously beneficial for medical education, clinical research and practice monitoring.

These latter reasons form the logic for my appeal to physicians to consider carefully how EMRs can help them in their practices and in service to patients. No one disputes the claim that EMRs will foster higher quality care for our patients. This should be reason enough to make the necessary commitment to implement an EMR.

But two other reasons seem as convincing to me as the first.

An EMR will make considerably easier and more accurate the process of following the progress of patients receiving clinical interventions. An EMR will let those physicians who so desire to join into clinical protocols. Clinical research will be revolutionized by the ability to enroll both physicians and patients easily, and acquire, store, retrieve and analyze huge amounts of data.

EMRs will have an equally revolutionary impact on the documentation of practices of individual physicians or physician groups. I have long been a strong proponent of peer review. And although I'm aware of shortcomings in some review systems, I am committed to any technology that makes it easy to document daily practice patterns and outcomes in a fair and unbiased manner.

That is precisely what an EMR provides.

As you read this, there are those in government and the insurance industry attempting to co-opt these critically important functions with thinly disguised, hastily designed pay-for-performance programs. To assume that either government or underwriters can keep pace with medical progress is hopelessly naïve.

This can be done properly only by you and your specialty societies.

All of the advantages of an EMR are exciting and persuasive. There remains one very important caveat, however. The EMR must not interfere with a physician's traditional role as custodian of patient-provided information or with physician access to the information related to sound professional judgments.

Insurers, employers, the government and others feel that they should control the data flowing from the EMR. Each is crafting arguments supporting their parochial views, which might not coincide with the patient's best interests. It is up to us -- to our profession, to our professional organizations -- to help our patients, who are concerned that their data are confidential, secure and inviolate.

I believe that certain anonymous, unidentified data can be shared with appropriate groups. This does not mean, however, that anyone other than physicians and patients should have unlimited control. These data are too sensitive and personal to be used or abused by those who have motives that could go beyond science and quality of care.

The medical profession and AMA policy clearly and unequivocally recognize legitimate patient concerns. And while I recognize the enormous power of government and of large national insurance firms, I also understand that we have the most potent force for change at our disposal.

The simple fact is that our patients, our greatest allies in this battle, are concerned about revealing the kinds of information they only confide to their physicians -- and to no one else.

If asked, I have no doubt at all that the patients of America will resoundingly choose physicians over any other custodian of their medical information.

I hope you will join me in encouraging all physicians to incorporate an EMR into their practices.

I hope you will cooperate with your specialty societies in designing systems of data storage and, more vitally, data access that ensures that sensitive information is used for valid research by legitimate medical researchers, that the privacy and integrity of patient information remain inviolate.

Leaders throughout the profession already are at work studying ways EMRs should be designed and ought to be used. I hope you will support those leaders and those efforts.

The EMR is not a threat. The EMR is an opportunity. Implemented in the proper way, EMRs can open the door to a much more productive, effective, higher quality medicine in America.

William G. Plested III, MD is a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07.

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