The Electronic Medical Record: Efficient Medical Care or Disaster in the Making? Dale Buchbinder You are the Chief Information Officer (CIO) of a large health care system. Medicare has mandated that all medical practices seeking Medicare compensation must begin using electronic medical records (EMR) . Medicare has incentivized medical practices to place electronic medical records in their offices by giving financial bonuses to medical practices that achieve certain goals. These EMR systems are supposed to allow communication between practitioners and hospitals, so medical information can be rapidly transferred to provide more efficient medical care. The EMR will enable physicians to allow access to the records of their patients by other providers. Eventually these records are supposed to be easily accessed so any physician or hospital will have complete medical information on a patient. The physician practices in your health care system have been mandated to use the Unified Medical Record System (UMRS). The UMRS was designed by a central committee; all hospital-owned physician practices have been mandated to use the system. As part of the incentives, Medicare will add dollars back to each practice when they meet goals for reaching meaningful use (MU). MU has been defined by the U.S. Department of Health and Human Services (n.d.) as "using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information." It is a step-by-step system requiring "electronic functions to support the care of a certain percentage of patients" Qha, Burke, DesRoches, Joshi, Kralovec, Campbell, & Buntin, 2011, p. SPl 18). One of the hospitals in your system has many primary care and specialty practices; however, the UMRS system was designed primarily for the primary care practices. The committee that developed UMRS did not take into account the needs of the specialty practices, which are significantly different from the primary care practices. This issue has been brought to the fore from by several medical specialists who have stated UMRS is not only cumbersome, but also extremely difficult to use. UMRS also does not give the specialist the information he needs. Specialists noted that after UMRS was implemented, it took them approximately 10 to 15 minutes longer to see each patient. Since an average day for a specialist consists of seeing between 20 and 25 patients, adding 10 to 15 minutes per patient adds 200 to 250 additional minutes, or 3 to 4 hours more each day. And, the physician cannot see the same number of patients each day. In reality, this represents a 30% decrease in productivity because of the amount of time it takes to use UMRS. Now the specialist office schedules constantly run significantly later than they should, and patients become unhappy and impatient. Several of the specialists reported that a number of patients have gotten up and left without being seen. In short, the mandate to use UMRS has impacted the efficiency and productivity of the subspecialists and specialists, further decreasing revenues for the system. In addition, all of the physicians have complained the UMRS does not communicate well with other electronic medical record systems, or even the hospital's own patient information systems. There is no real integration of the medical databases as intended, levels of meaningful use are unclear, and in some areas, difficult to achieve, again because the UMRS was tailored to primary care practices' prescribing patterns. Specialists, particularly surgeons, do not write a large number of prescriptions. Surgeons have been mandated to write electronic prescriptions to reach meaningful use; however, in many cases this is not appropriate for surgical patients. All of these issues and concerns were reported to the central committee that created UMRS in response to federal mandates and financial incentives. The committee responded it cannot modify the system to make it more friendly to specialists and subspecialists, despite the fact that procedures performed by the subspecialists account for substantial revenues. Revenues are down and the morale of the specialists and subspecialists has plummeted to the point that many are talking about taking early retirement or leaving the system. Still, the committee refuses to fix the problems. Since you are the CIO of the entire health care system, the situation is now in your hands.

1) Is there a way to bring consensus and standardize the EMR systems without alienating productive physicians who bring large revenues to the hospital? How can the dilemma of inefficiency and patient dissatisfaction be prevented? Create and present a plan for how EMR could be implemented in a system with multiple types of practices. Be sure to address the issues of physician specialty, productivity, and satisfaction, as well as patient satisfaction.

2) What steps should the CIO take in the future to prevent these types of issues from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.