乌鸦传媒

There definitely seems to be a lot of good that's coming from newly being on a unified electronic medical record (EMR) across all of our hospital systems.

Until just recently, our hospitalized patients were taken care of on the inpatient services under one EMR, and our outpatient practices used a different one. And all of our different regional hospitals, including our two largest academic medical centers, used different systems, speaking different languages that made cross-talk nearly impossible.

Just the recent experience of bringing these all together shows how critically useful having all of our health information contained in one place could be. It could lead to better care for our patients, and a better healthcare system overall.

Somebody being admitted from the outpatient world to the inpatient world can more seamlessly be transferred across from the outpatient clinic to the emergency room to the inpatient admitting team. We no longer need to print a copy of our note and hand it to the paramedics to give to the emergency department (ED) providers so they know what we are worried about. And our colleagues in the ED can quickly and easily see our patient's past medical history, social history, medications, and allergies, with much less need for retyping a whole lot of data over and over again.

In the old days, the emergency department's medication reconciliation for outpatient medicines included an option that imported the medicines the patient was given during their last ED stay in our hospital, so often providers were clicking that a patient was (still) taking an antibiotic, a pain medicine, or an inhaler, or something else they had been given on discharge from that last ED visit, instead of their actual home medication list. And over and over again, our patients got flu shots and pneumonia vaccines during an inpatient admission when we had only just recently given them to the patient in our office.

How nice it has been for a consultant to now quickly and easily see the entire medical history documented in the charts, and not have to re-create the wheel again and again.

Having been a patient at my own hospital, I can tell you how silly it feels, the many times I've had to fill out yet another paper form that listed my past medical history, my medicines, my allergies, when they were in fact right there in the system, but we hadn't gotten smart enough to figure out how to just do this the right way. I can imagine that being on one system will prevent over-testing and wondering what our colleagues were thinking and why our patients were there to see us that day.

How many of us have had a patient say that some doctor sent them to see us for some reason, but they left those papers they told me to give you on the table at home? Only the next day do you learn it was meant to be a pre-op visit for urgent upcoming surgery.

There are still problems, and kinks that need to be worked out. We have new Inbasket folders with tantalizing names like "Outside Events" and "Outside Messages," but at least for now these are more promise than payoff. And if you click on the link that says your patient was seen at an outside hospital, instead of finding a useful report you are taken to a place where you can only see what happened if the patient signs a paper consent in front of you today (which they usually cannot do, since they are most likely home after just being seen at an upstate ED). Or it leads to a really long, not-too-useful report that eventually shows that the patient was "admitted" to another medical center's radiology department for an imaging study someone else ordered.

I'm not saying that I want any particular vendor to win; no one should have a monopoly on the EMR business, but wouldn't be great if we could someday get to that place where everything was there for everyone to see and for everyone to use? Imagine that someday we'll be able to overcome the barriers of interoperability, of proprietary servers and software, of concerns over privacy and hacking of data, and get to a place where this part of healthcare could become effortless. We could potentially eliminate the risk of patients getting the wrong medicines, or of operating on the wrong part of their body, if our systems learned to just all get along.

The model of unifying this care across our enterprise will hopefully pay off enormously in terms of health advantages, and potentially eliminate health inequities. We could harness the sheer size of the database to spot emerging trends or uncover barriers to care or where our care is lacking. Gaps in care will be easier to close, and places to pour resources will become more obvious.

No matter where a patient goes in our system, they know they are one of ours, we know they are one of ours, and we can get them the best care that they need, without a lot of fuss, a lot of faxing, a lot of second-guessing.

I remember 20 or so years ago seeing some commercial where everyone had their complete medical records embedded on a chip in their credit card. And today, our smartphones can, if we're diligent enough to manually enter all the right data, tell the emergency room or paramedics who find us obtunded what our health conditions are, and help guide them towards potentially life-saving treatments. But if all of this data was easily, instantly, infinitely available, think how much better care we'd be able to take of every single person in every situation they presented in.

I don't think any of us wants to have a chip embedded in our heads, but making all of this information universally available -- easily, seamlessly, painlessly -- should be a goal we're willing to work towards.

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