Electronic Medical Files: Economical Or Not?

One of the suggestions being openly debated by government leaders regarding health care legislation that will hopefully result in reducing medical expenses and increasing patient care is converting paper patient files to electronic patient files.

Electronic files sound like a positive change. With the push of a computer button, electronic files could assist doctors in more easily and more quickly transferring a patient’s medical record to specialists, to consulting physicians, or to hospital emergency rooms during situations when moments can mean the difference between life and death. It could help a doctor treating a new patient or a pharmacist filling a prescription for a new customer to immediately check for any possible drug interactions, drug allergies, or to know what prescriptions have been previously tried. Electronic files may actually be able to save duplicated tests, procedures, or treatments, or they could save a life.

For the physicians who completely convert to electronic records, it would save valuable office space, space that could be then used as additional exam rooms or as an area for additional medical equipment such as an in-office x-ray machine or a small in-office lab. Another use for the newly available office space might include a comfortable consultation room where doctors and patients could further discuss diagnoses, treatment plans, or possible outcomes.

Yet, for all of the positive potential of electronic records, there are some negative issues, too.

Anyone who works in an office knows that, typically, there is a paper file maintained to support the electronic file. The workload required of keeping a client file is not reduced by creating an electronic file; rather, it is doubled. Paper files are maintained, particularly in regards to important patient or client records, because electricity can fail temporarily, computers can fail or crash, computers can catch viruses or malfunction. And, the greatest issue regarding electronic files is data entry errors that can occur when typists incorrectly read a hand-written note, when typists are busily attempting to enter data into multiple patient files with multiple tabs on the screen simultaneously, or when the simple act of a typo occurs when entering the dosage or strength of a prescription.

Electronic files are much more expensive than paper files as well, a cost that will, no doubt, be passed on to the patient. Currently, doctors have paper files to search through, refer to, and hold in their hands as they speak to a patient. With electronic files, a computer connected to a mainframe would need to be present in each exam room so that the doctor could have access to the information. Computer programmers and computer maintenance technicians would have to be hired. New electrical wiring and maintenance to the wiring would be necessary throughout medical facilities to support the new computers. Finally, with all of this new workload of keeping two files on each client, new office personnel will need to be hired for data entry.

Yet, other questions exist regarding electronic files. If the electronic filing system is to be consistent so that doctors in different states can have immediate access to medical information, then there will need to be only one universal computer system available to any medical practitioner. Who decides what type of system it will be and how it will function? This could create a problem since some physicians in some locations may be unable to afford expensive computer systems or computers large enough to support such a program, possibly resulting in smaller, rural areas losing their physicians to clinics in larger cities.

Another issue related to the computer system is data entry. In addition to the potential for data entry errors, there is also the issue regarding time frames for entering the medical information. A patient may be treated in the morning at a local physician’s office, receive a prescription, and require an emergency visit in the middle of the night. But, what if the physician’s office staff was busied that day and did not or could not enter the updated information prior to the hospital visit? Electronic files have their advantages, but nothing will ever truly be better than an old-fashioned phone call and a consultation.

Finally, of prime importance, is the issue of privacy. If there will exist a national computer system so that medical practitioners can have instant access to a medical file—even if the patient is vacationing from out-of-state, there will be a need for security for the site, such as usernames or passwords. Who will have access to the files, which will probably not only contain medical histories but also addresses, phone numbers, emergency contacts, and, for patient identification purposes, a social security number? Will it be the doctors, the general practitioners, the dentists, the surgeons, the optometrists, and the other doctors who treat patients in any form? Doctors are often quite busy, particularly in emergency rooms. And, since doctors are sometimes on-call and en route as opposed to on-site when the information is needed, the administrators of medical facilities may need clearance. But, then, administrators aren’t always available either and, as we know, nurses do quite a bit of medical work. The nurses may need clearance. Then again, nurses are also quite busy and the nursing techs, who often deal with the patients one-on-one, may need some limited clearance to the medical records of their patients. Pharmacists will need clearance to know what prescription to fill (paper scripts will be gone) and to be able to double-check for potential interactions. What about the ambulance drivers and emergency medical technicians? Since they are usually the first on the scene, they would require clearance. What if a patient decides to go to a holistic practitioner or to someone practicing alternative therapies? It would be beneficial to have this information in the medical record to prevent possible interactions between herbal remedies and prescriptions, but then the practitioners of alternative treatments would also need clearance. Of course, anyone entering the medical data into the electronic files would require clearance. The insurance companies employees reviewing customer policies to determine whether or not a test is warranted or whether a bill will be paid will need clearance. And, anyone who has ever had a computer system knows that all too often usernames and passwords are written on paper and posted somewhere where they could be found and used unlawfully by those without clearance; other times, the codes are given by someone with clearance to someone without clearance when instant access to information is needed and time is an issue; and, yet at other times, computer systems are hacked into by unscrupulous individuals.

In an age where people are treated by multiple doctors, be they general physicians, specialists, dentists, optometrists, etc., electronic files can help to maintain medical histories over the course of decades in one tiny little computer space without worry of fading or becoming lost in storage, and they can quickly transfer information. But, electronic records come with their hazards and with their limitations, and they will inevitably be an additional expense to the patient and a significant risk that private information will find its way into the hands of people who have no use for it. So, the question remains: Are the benefits of electronic files worth the expense and the risks? Or, could a phone call and an old-fashioned paper file that has been diligently maintained post similar benefits with minimal risk and expense?

Perhaps, what is needed is not a national medical file database; rather, perhaps a more localized electronic database is called for, a database that could house the information provided for any patient being treated by multiple doctors, but a file that would have a very limited number of people with clearance to the information. A localized file, combined with a phone call and an electronic transfer of the medical file when a patient is treated out-of-area, may be a less expensive and less risky yet beneficial path to follow.