Electronic health records: The pros and cons

October 7, 2010

Dan TennenhouseDan Tennenhouse, MD, JD, FCLM

More and more doctors are converting their medical records from paper to electronic. Popular acronyms for this trend include EMR (electronic medical records), EHR (electronic health records), EPR (electronic patient records), and CPR (computerized medical records). Whatever you call it, the trend toward digitizing our health records brings many benefits, along with some risks and hidden costs.

The “pros” of electronic health records

The benefits to using electronic health records are numerous, and doctors who don’t use them can be criticized for failing to invest in a tool that can prevent certain poor patient outcomes.

Some of these benefits include:

  • Better sharing of records. With a central database, the patient’s entire record is always available to hospitals, clinics, emergency departments, consultant’s offices within the network, and other facilities where care is provided.
  • Better legibility of records. Unlike handwritten records, electronic records can be read by everyone.
  • Easier patient follow-up. Electronic records make it easier to monitor for medication use, patient compliance, changing symptoms, immunizations, recall notices, automatic reminders and alerts, and other factors.
  • Easier product recalls. Electronic records make it possible to notify patients who have received products or medications later found to be dangerous or defective.

In addition, many record-keeping programs can also improve the quality of care by:

  • Reminding the clinician of every listed patient problem on every office visit, and incorporating practice guidelines where appropriate
  • Incorporating more preventive care into treatment protocols
  • Requiring entry of all relevant findings to assure adequate history taking and physical examination
  • Requiring completion of consent forms and other legal documents, and automatically printing customized forms
  • Making statistical comparisons to identify the most effective and least expensive modes of therapy
  • Creating charts and graphs that show patient progress in key areas like weight loss, blood pressure, and cholesterol level
  • Printing prescriptions and retaining a complete record of medications prescribed and ordered
  • Checking drug interaction databases and alerting the prescriber to potential errors involving drug allergies, incompatibilities, and overdose
  • Printing customized patient instruction handouts automatically
  • Eliminating many common medical record filing errors and lost records

The “cons” of electronic health records

There are risks and pitfalls associated with electronic health records, and doctors who use them can be criticized for failing to minimize those risks.

Some of the risks and hidden costs include:

  • Omission of paper medical records that were not electronically scanned
  • Additional time to complete all required fields in a structured record-keeping program
  • Delays in initiating proper medical care if computer protocols must be completed first
  • Delays caused by network downtime or loss of computer data
  • Investments in effective firewalls to protect the confidentiality of each patient’s medical information
  • Investments  in costly computer system upgrades to optimize performance

One final pitfall involves the potential unreliability of electronic medical records as evidence. If computer records can be modified without leaving an indelible trail of data, late alterations would not be distinguishable – which can damage the credibility of the records as evidence.

For more on electronic health records, see Attorneys Medical Deskbook, 4th, sections 1.2, 1.2.1, and 2.4-2.6.

Dan Tennenhouse, MD, JD, FCLM, is a graduate of the University of Michigan School of Medicine and the University of California Hastings College of the Law. He teaches legal medicine at the University of California San Francisco School of Medicine and practices as a medical legal consultant for attorneys. Dr. Tennenhouse is the author of Attorneys Medical Deskbook, now in its fourth edition.