Most of us see several different doctors and other health care providers based on our specific health care needs. Each one of these providers maintains their own medical record on us that includes information such as our medical history, physical examinations, laboratory and imaging reports, medication lists, consultations, diagnoses and treatment.
Traditionally, doctors recorded and stored this information in paper records kept on file at their offices. Over the past 10 years, an electronic form of this age-old practice, known as the electronic medical record (EMR), has become an increasing reality.
EMR adoption by physicians is steadily on the rise and has already demonstrated several quality and efficiency benefits for health care. But EMRs alone are not enough.
The next critical step in the process is to create a way for the EMRs that contain our vital medical information to be readily available when and where it is needed to diagnose and treat us. This is especially important for emergency care.
Here is an example from my practice that illustrates exactly how immediate access to such information by authorized medical personnel can help improve the quality, safety and efficiency of patient care:
A patient came to see me after a fainting episode. The patient had a known history of heart disease that was being managed with multiple medications and close monitoring by both his internist (me) and a cardiologist. I obtained an electrocardiogram which revealed no new changes and, after consulting with the cardiologist, the patient was continued on medical management. The electrocardiogram (EKG) was stored in the patient’s EMR file.
Four days later, the same patient went to a local emergency room around midnight with chest and abdominal pain which had lasted about two hours. The electrocardiogram obtained in the emergency room revealed a pattern consistent with acute myocardial infarction (heart attack). If the Emergency Room physicians had a way to quickly access the electrocardiogram from four days earlier, stored in my EMR, they would have been able to determine that no new changes had occurred and that the patient was not having a heart attack.
Without access to this critical information, cardiology determined that clot-busting medication was warranted. The medication was administered to the patient with his consent. The patient’s chest and abdominal pain persisted and he was transferred to another hospital where subsequent testing revealed pancreatitis (an inflammation of the pancreas).
In the meantime, the strong clot-busting drug had resulted in the possible adverse effects of bleeding in the brain and the pancreas. Fortunately, the patient improved and was discharged from the hospital several days later with no residual effects.
If all of the doctors involved in the process of treating this patient had electronic access to his medical records, it is unlikely that he would have received the clot-busting medication and suffered its associated complications. This is one of thousands of scenarios in which access to precious medications, tests and medical history data at the point of care is critically important in making immediate medical decisions.
Fortunately, Rhode Island is a leader in the promotion of EMR adoption and a project is currently under way to create a statewide system that will allow patients to authorize their doctors and other health care providers to effectively share information with each other when needed in order to improve care, help prevent duplicate tests and reduce medical errors. These efforts are led by the Rhode Island Quality Institute – a statewide collaboration of hospitals, physicians, nurses, health insurers, consumers, business, government and academia working together to significantly improve health care in Rhode Island.
In addition, legislation has been introduced (the R.I. Health Information Exchange Act of 2008) that has passed the House and Senate and awaits the governor’s signature. It safeguards all patient information exchanged through the system. Initial timelines indicate that voluntary patient enrollment will begin this summer and participating health care providers will be able to begin using the system by March 2009.
This statewide health-information exchange system can only succeed with the support and participation of the patients it is designed to benefit. As a physician, I know firsthand exactly how this system will benefit my patients. In the coming months, my staff and I will be taking the time during office visits to explain this valuable new health care tool and advising them to enroll. I strongly encourage every other health care provider in the state to do the same. •
Nitin S. Damle is a primary care physician / internist in Wakefield; a member of the board of directors of the Quality Institute of Rhode Island; and governor of the Rhode Island chapter of the American College of Physicians.
