The difficulty of digital medical record keeping

Throughout the debate about so-called Obamacare, one topic that particularlyinterested me was the push to digitize medical records.  Digitizing records makes so much sense and is almost universal practice in profit-oriented American companies – how has it taken this long to apply the practice to medicine?  Digitizing records should be even more important in medicine than in many other industries – my allergist in NY needs to know what my allergist in Michigan and my general practitioner know or else they might not have all the relevant facts to treat me.  Paper record sharing is far too burdensome to allow this, among many other things, to happen. 

I was interested in this article:  http://blogs.wsj.com/health/2010/08/18/study-only-advanced-electronic-medical-records-reduce-er-time/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+wsj%2Fhealth%2Ffeed+(WSJ.com%3A+Health+Blog)&safe=on&mod=smallbusiness about a study that showed that although ERs with advanced digital record-keeping systems have about 20% lower wait times than those with little or no digital record keeping, those with mixed systems have wait times 47% longer than those with no electronic record keeping for those with urgent or semi-urgent issues.  The kicker: only 1.7% of the ERs in the study had fully functional digital record keeping. 

This is a situation where the upfront cost is high, but the long-term payoff is huge and really essential to the future of health care.  Independent studies have shown the Obama plan to create a standardized computer record-keeping system for the nation would cost a whopping $75-100bn to implement; however, some estimates show that once in place, it could save between $200-300bn/year – see http://money.cnn.com/2009/01/12/technology/stimulus_health_care/. 

I think the key implication of the first study is that these record-keeping systems have to be designed extremely carefully in order to have the full impact possible.  While the advantages of the switch go well beyond decreasing wait times at ERs, there are many ways a system could be created that would cause more harm than good.  It’s something that we absolutely have to get right the first time – an intuitive, practical, and standardized system of medical record-keeping would be a powerful tool in reducing costs and improving care in the medical system.  Creating this – see the above article for details – will require clearing some rather high hurdles, but I think it’s a very worthwhile point of focus in the process of health care reform.