The Electronic Medical Record: Promises and Pitfalls

Jacob Reider, MD

In This Article


Editor's note: This is part 1 of a 2-part series of articles on EMR implementation.

Electronic medical records (EMRs) have evolved from their early days of command-line text entry to point-and-click, template-driven charting and office management systems that attempt to meet the needs of the user rather than to coerce us to navigate a complex text system. Usability has finally become a bullet point on the "feature matrix" of many EMR software vendors. The name of the software category has changed from EMR to CPR (computerized patient record) to EHR (electronic health record).

While the nomenclature and feature set may differ somewhat, and systems may offer varying degrees of integrated practice management assistance, the core goals of most systems are to improve physician and practice efficiency, improve quality of care, and improve the accessibility of stored patient information. Browsing this list of EMR products (complete with vendor) on Dr. Kirk Volker's Web site reveals that the promises of EMR software remain extraordinary. With phrases like "time-consuming customization is eliminated" and " easy to learn, incredibly inexpensive, and markedly improves the efficiency of documenting the medical encounter," one wonders why anybody uses paper and pen at all! We should just purchase these systems and have them type our notes, remind our patients to get their mammograms, refill their prescriptions, and send the bills to the payers -- all in a flash.

While early studies on EMRs focused on why the systems were not embraced[1] and suggested methods of improving acceptance (measured by frequency of use), research in the mid 1990s shifted from the proposed solution (the EMR) to the problem itself. In order to develop an EMR that meets the needs of the physicians who will use it, we need to better understand how the physicians work, and develop the software with an eye toward solving real problems in outpatient practices rather than developing a "solution looking for a problem."