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Electronic Health Records and the National Health Information Network: Affordable, Adoptable, and Ready for Prime Time?

Peter Basch, MD
[+] Article, Author, and Disclosure Information

From MedStar Health, Washington, DC 20003.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Peter Basch, MD, MedStar Health, 660 Pennsylvania Avenue, SE, Suite 100, Washington, DC 20003.

Ann Intern Med. 2005;143(3):227-228. doi:10.7326/0003-4819-143-3-200508020-00009
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This issue contains 2 articles on different aspects of the “wiring” of health care in the United States. One article details the costs and difficulties of implementing an electronic health record (EHR) system in an internal medicine practice, and the other estimates the costs of building a national health information network (NHIN). Baron and colleagues (1) recount their small practice's predictable struggles and ultimate success with implementing an EHR. Their narrative is compelling and tells a story that many physicians will find useful and instructive. The authors also offer suggestions that could make this complex process easier for those who follow their lead. Kaushal and colleagues (2) approach the “decade of the EHR” from a national perspective, telling policymakers and politicians how much money they should allocate to build the infrastructure—almost $400 billion over 5 years—if indeed the United States is serious about moving from a siloed, paper-based system to one that is electronic and fully interconnected.

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Physician Authorship of Templates for EMR
Posted on August 15, 2005
Michael M. Rothkopf
South Mountain Medical Consultants
Conflict of Interest: None Declared

To the editor:

The articles by Kaushal, et al (1), Baron, et al (2) and the accompanying editorial by Basch (3) accurately outline the challenges we must overcome to accomplish the inevitable conversion from paper charts to a computerized health information system. However, an important factor regarding physician adoption of EMR has been overlooked by these papers and is absent from the national debate.

Virtually all electronic medical records programs make use of templates to facilitate rapid clinical record keeping and accurate CPT coding. The secret to effective use of EMR software lies in the ability to download relevant clinical templates over which the encounter documentation is layered. Such templates need to be created by physicians rather than computer programmers. They must meet the high standards of the physician-user who rightly expects them to facilitate accuracy, speed, competence and compliance. In addition, the templates must be natural to use in the clinical setting. After all, the encounter is the major interface point, not only between the physician and patient but also the physician and machine. If the templates are inadequate, the experience will be frustrating and physician adoption of the EMR will suffer.

We have written computerized templates for multiple specialties on several different EMR platforms. We have helped dozens of physicians integrate EMR into their practices. A common pattern has been observed: in order for EMR to succeed, the templates must conform to the physicians, not the other way around.

We agree that the grand vision of an integrated electronic national health information system will require a massive effort and investment as outlined by Kaushal, Baron and Basch. These steps are taking place on the large stage of government and corporate policy. But the ultimate success of EMR will rely on the degree of functionality delivered to an individual physician during a single, private patient encounter.

There is a great need for an association of physicians committed to the development and dissemination of clinical templates for EMR systems. Without the support of physicians willing to invest time on template development, the great potential of EMR will remain unfulfilled.

Michael M. Rothkopf, MD, FACP, West Orange, NJ

Herschel S. Jackson, MD, Murray, KY

1. Kaushal R, Blumenthal D, Poon EG, Jha AK, Franz C, Middleton B, et al. The costs of a national health information network. Ann Intern Med. 2005;143:165-73.

2. Baron RJ, Fabens EL, Schiffman M, Wolf E. Electronic health records: just around the corner? Or over the cliff? Ann Intern Med. 2005;143:222-6.

3. Basch P. Electronic Health Records and the National Health Information Network: Affordable, Adoptable, and Ready for Prime Time? Ann Intern Med. 2005;143:227-8.

Conflict of Interest:

Drs Rothkopf and Jackson have recieved composition for template authorship from: meridianEMR, mypatientcharts, docusyst and pocketchart

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