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Book Review  |   December 2011
Electronic Medical Records: A Practical Guide for Primary Care
Author Affiliations
  • Pat Anthony Lannutti, DO, MSc
    Chairman, Division of General Internal Medicine; Vice Chairman, Department of Internal Medicine; Core Director, General Internal Medicine, Philadelphia College of Osteopathic Medicine, Pennsylvania
Article Information
Book Review   |   December 2011
Electronic Medical Records: A Practical Guide for Primary Care
The Journal of the American Osteopathic Association, December 2011, Vol. 111, 694-695. doi:10.7556/jaoa.2011.111.12.694
The Journal of the American Osteopathic Association, December 2011, Vol. 111, 694-695. doi:10.7556/jaoa.2011.111.12.694
Electronic medical records (EMRs) provide a method by which we can identify patients who have suboptimal medical supervision and reach out to them proactively. So state the authors of Electronic Medical Records: A Practical Guide for Primary Care. This book alludes to the great potential benefit of population management that encourages a collaborative healthcare system with our patients. 
The editor of Electronic Medical Records, Neil S. Skolnik, MD, is a professor of family and community medicine at the Temple University School of Medicine's Abington Memorial Hospital in Abington, Pennsylvania. The contributors to the 7 chapters of Electronic Medical Records include 3 allopathic physicians (in addition to Dr Skolnik) and 3 other individuals with relevant clinical experience. 
Chapter 1 reviews monetary incentives for EMRs and delineates the meaningful use of these systems. However, one wonders why incentives should be necessary if the EMR system is inherently so laudable. The authors provide a detailed review of “meaningful use” according to the Centers for Medicare and Medicaid Services, and they suggest that the EMR process is evolving. Much emphasis is placed on computerized physician order entry for retrieval of information (eg, drug-drug interactions, hypersensitivities, clinical laboratory tests, comparative graphs). This chapter also postulates that the various individual EMR systems will eventually interact. 
The authors conclude the first chapter by noting that “the federal government has embarked on an ambitious agenda to increase the number of physicians using EHRs [electronic health records] to almost universal proportions by 2014” through a “carrots-and-sticks” approach. The government's goal is to improve the quality, safety, and efficiency of care that physicians provide and to fully realize the technological promises of EMRs. 
Chapter 2 offers so-called “candid, first-person accounts of primary care physicians' experiences with a variety of EMR systems from a variety of settings” for purposes of “inspiration and consolation.” Some of the more intriguing and unfavorable remarks about the effects of EMRs made by the physicians are the following:
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    takes 50% more of a physician's time
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    requires more time to fill prescriptions
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    requires a 2- or 3-year transition
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    mainly benefits hospitals
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    can cause a loss of income
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    negatively affects patient relationships
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    interactions with patients become more impersonal
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    may lead to attrition of physicians
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    previous computer expertise is an enormous advantage
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    physicians must type well and not rely on voice recognition (most EMR systems are not voice activated)
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    risk of violating privacy standards of Health Insurance Portability and Accountability Act
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    privacy and safety can be at odds and present substantial challenges (ie, open architecture vs protecting privacy)
More favorable remarks made by the physicians about EMRs include the following:
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    efficiency improves (eg, patient numbers, revenue)
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    patients receive better care
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    preventive services are enhanced
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    chronic conditions are managed to a higher degree
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    charts are more legible
In chapter 3, the authors suggest ways of choosing from the various EMR systems while acknowledging that EMRs are not standardized commodities. In terms of details, unfortunately, this section is becoming obsolete. With respect to the conceptual approach outlined in the chapter (eg, step 1: identify your decision maker; step 2: clarify your goals; step 3: research your options…), anyone who has decided on an EMR system will already have developed this approach. 
Chapter 4 reviews the need to reorganize the office in terms of an intelligent transition, including the benefits of a point person or physician champion and a workflow analysis. The authors point out that the patient needs to be apprised of the advantages, as well as the impersonal impacts, of EMR systems. 
The salespeople (ie, vendors) will instruct all pertinent personnel on how to use any EMR system that is purchased. Thus, the details of system implementation described with dizzying precision in chapter 5 are overdone. There is a similar problem with chapter 6, which is referred to as “the owner's manual part of this book.” Why would one need this part of the book when one would have the specific owner's manual for the EMR system that has been thoroughly investigated and purchased? 
I find it fascinating that after 114 pages of dense, dry dogma purporting to be a practical guide to EMR systems for primary care physicians, the authors make the following vague and murky comment about these systems at the end of chapter 6:
 

Maintenance and optimization are where the rubber meets the road for an EMR. They are complex and intensive efforts. When done with care, they might lead you to Taoist enlightenment, or maybe just a successful EMR implementation and better care for your patients. Your results may vary.

 
Chapter 7 closes out the book with comments from vendors about what physicians should look for when purchasing an EMR system and about expected changes in the EMR industry. 
A smaller, simpler manual written after the dust has settled and after the Centers for Medicare and Medicaid Services and the professional regulatory advocates and agencies have made their final rules and regulations on EMRs would be much more useful than this book. At this point in time, the book's suggestions are too speculative and general. 
Another unfortunate aspect of this book is the lack of a section about patients' reactions to the advantages and disadvantages of universal EMR. On the positive side, the physician commentaries section is reasonably accurate and reflects the everyday pros and cons of EMRs, which represent a major reformation of American medicine and the quality of its delivery.