Letters to the Editor  |   February 2008
Electronic Medical Records: What Are You Waiting For?
Author Affiliations
  • Robert R. Zaid, DO
    Genesys Regional Medical Center, Grand Blanc, Mich, Intern/Resident Representative, American Osteopathic Association Technical, Advisory Bureau
Article Information
Medical Education / Professional Issues / Graduate Medical Education
Letters to the Editor   |   February 2008
Electronic Medical Records: What Are You Waiting For?
The Journal of the American Osteopathic Association, February 2008, Vol. 108, 81-82. doi:10.7556/jaoa.2008.108.2.81
The Journal of the American Osteopathic Association, February 2008, Vol. 108, 81-82. doi:10.7556/jaoa.2008.108.2.81
To the Editor: As a child, I spent many days watching my parents' computer technician solder chips onto a motherboard to repair various computer problems. I eventually realized that if I could learn how to fix computers for the small business my parents owned, they would no longer need to pay someone else for the repairs. 
Through the years, after experimenting with an assortment of computerized devices and software programs, I have learned that technology is generally beneficial—but not all new developments are worthwhile. In fact, some developments can make one's life more difficult. 
During my years in medical school and, now, in my residency program, I have made a number of other observations about technology, including the following: 
  • There are countless opportunists who would like to cash in on physicians' perceived wealth, charging exorbitant fees for electronic products that may not be exactly what a physician needs.
  • Many physicians want to embrace technologic innovations, but they hesitate to make decisions about which products to use. Physicians, for the most part, do not want to be technology pioneers.
  • Many physicians are unable to communicate well with computer programmers because they do not understand the technical language used by programmers. As a result, physicians often do not use their computer systems to their fullest potential.
Physicians in family practice make complex decisions every day. Yet, we seem unable to decide which system of electronic medical records (EMRs) to use. One probable reason that physicians in family practice hesitate to select an EMR system is because they expect their parent hospitals will make that decision for them. However, it may not be in a physician's best interest to use the same system preferred by his or her parent hospital. In such institutions, the decision about which EMR systems to purchase are typically made by administrators who select the best program for general hospital purposes—not for the individual needs of any particular physician. 
Furthermore, it is not essential for a physician to have the same EMR system used by his or her hospital. Most hospital computer record systems allow for remote access of patients' records by physicians. All EMR systems use a digital code language called HL7 (Health Level Seven Inc, Ann Arbor, Mich).1 Thus, as long as a physician's files are compatible with HL7, patients' data can be imported from electronic hospital databases by using the physician's own EMR system. 
Of course, any new technological device or system is initially going to be a challenge to work with, and this is true for EMR systems. Nevertheless, I believe that there are many advantages for physicians in learning to use their own EMR systems. As requirements of Medicare and private insurance companies continue to generate increasing amounts of documentation for physicians—and as physician reimbursement continues to decline2—physicians need to use patient-record systems that are as efficient as possible, that minimize errors, and that improve preventive care. By using the right EMR system, tailored for the specific needs of a physician's practice, these goals can be achieved. Thus, the selection of an EMR system must be based on sound judgment, considering the needs of a particular practice. In addition, physicians should maintain close relationships with computer programmers to help them keep abreast of future updates to software. 
Genesys Regional Medical Center in Grand Blanc, Mich, where I am a third-year resident, has an excellent collection of electronic aides, records, and databases. However, not all of these electronic media are linked with one another to facilitate easy and complete access to all available data. 
Since I began my residency at Genesys in 2005, I had heard about the center's plans to transition to paperless medical records and wanted to learn how to use an EMR system. 
In October 2007, I attended an American Academy of Family Physicians conference in Chicago, Ill. This conference gave me the opportunity to visit with representatives from several software companies and ask them questions about their products. 
I have since experimented with three EMR systems—Misys (Misys Healthcare Systems, London, England), AltaPoint (AltaPoint Data Systems, Midvale, Utah), and Amazing Charts ( Inc, Hope Valley, RI). My work with these EMR systems has led me to conclude that, though there are some differences among the systems, they all allow the user to accomplish many of the same tasks. 
I decided to download Amazing Charts, which is free for the first 90 days of use.3 It has now been 3 months since I started using this system in my clinic. Each day, I learn something new. Because I am experimenting with this software on my own, the use of the program requires more work on my part than would normally be necessary, including typing up patient records, inputting vital data, and printing out copies of the data for the patients' records. 
Using the EMR program was difficult and time-consuming at first, but after the fourth day of working with the new system, I became much more adept at using the electronic templates, and I began completing my charts before the other residents had completed their dictating. Although I need to type in data that would normally be typed in by a medical assistant, I have found that, by the second time I see a patient, the patient's record is almost complete—requiring less time than dictation. With the use of voice-recognition software, I have cut my record-compiling time in half. 
Because, as a resident, I see only about 16 patients a day, I have had time to master the Amazing Charts software and to determine which software features are most useful and important to me. I have also submitted my ideas on improving this software program to the manufacturer. It is my hope that they can adapt the program to better meet the needs of physicians such as myself. Even if I later decide not to use Amazing Charts, I have developed the skills to work with an electronic medical chart on a computer—skills that are readily transferable to other EMR systems. 
I strongly recommend that other residents take this matter into their own hands and learn how to use the EMR systems of their choice. While in residency programs, we learn from our preceptors how to practice medicine, but I believe that it is also essential for us to share our knowledge about computer technology during residencies. That two-way interaction is the only way to bridge the gap that exists between the practice of medicine and the use of computers. Understanding and using EMR programs is important if we want to move forward in the medical profession, which is increasingly dependent on technological developments. 
Establishing electronic records for patients can be a huge task initially, and the first year of inputting data can be tiresome. Yet, once that information is placed into computer files, a physician's practice will likely operate much more efficiently. Physicians need to move from procrastination to action with EMRs. 
What are you waiting for? 
 Editor's Note: Dr Zaid discloses that he has no conflicts of interest related to the topic of this letter to the editor.
What is HL7? Health Level Seven Inc Web site. Available at: Accessed December 19, 2007.
Hariri S, Bozic KJ, Lavernia C, Prestipino A, Rubash HE. Medicare physician reimbursement: past, present, and future. J Bone Joint Surg Am. 2007;89:2536-2346. Inc. Software pricing. Available at: Accessed December 19, 2007.