EMR: An Ethical Analysis

In 2010 the U.S Senate approved an $838 billion dollar stimulus bill pushing electronic medical records (EMR’s) for all medical facilities. President Obama implemented a mandate that all medical records are converted into an electronic format by 2014. Fast-forward to 2012 and the majority of medical facilities have yet to convert to EMR’s. With less than two years to go before the mandate why is there so much hesitation from medical facilities? What will happen if medical facilities don’t convert medical records to an electronic form?

For a review, only 48.3% of hospitals around the United States have implemented using EMR’s. Currently, paper-based records are still the most common method of recording patient information.  While many medical facilities are switching over to the use of EMR’s many medical facilities are finding change and the cost of switching over to EMR’s hard to come to. Implementing EMR’s includes costs such as training every employee, purchasing new equipment and software, and possibly hiring additional staff to ensure that EMR’s are being properly run. All these costs can be hard to manage for smaller medical facilities.   

“2014 is an important year because from 2015 onwards, penalties are likely to be levied on entities dealing with patient healthcare data unable to upgrade themselves to electronic record technologies. Legislations like the ARRA and the entire campaign promoting EMR is based on the principle that electronic records provide the combined benefit of securing patient information and cutting down healthcare costs—two irrefutable advantages.” (www.edoscan.com)

It should be noted that the proposed penalty in 2015 is of 1% and this is likely to increase incrementally, up to 5% in the forthcoming years. Most of the penalties will be levied in the form of reduced Medicare and Medicaid reimbursements.

Even with an $838 billion dollar stimulus bill, switching all paper-based medical records into an electronic format is going to cost medical facilities a ton of money. In order for a medical facility switching over to EMR’s this means finding an EMR vendor that complies with regulations that have been put forth, such as the standards set by the Security Rule of HIPPA.

There is a lot of hesitation from physicians because medical practices already have a lot of government interaction and by mandating the use of electronic medical records is another way the government controls what they do. I personally agree with the physicians’ because its their money that’s going into a medical practice, why should the government tell them what format their medical records need to be in? Yes, there is a stimulus bill for converting to EMR’s but who knows how much hospitals will really get for converting to EMR’s?

I am very much for the use EMR’s but I don’t think that they should be mandated on medical facilities. It takes time to learn a new system and by pushing facilities to switch over could mean more chart errors and inadequate training for staff.

A good example I have of a company improperly implementing the use of EMR’s is the eye clinic I work for. The eye clinic consists of four physicians, three of which are against EMR’s and the other one is all for converting to EMR’s. I was hired to work on converting their paper-based charts into an electronic form for that one physician; it may sound simple, but it’s a headache because when converting you either go all electronic or all paper, there is no half and half. The issue with the eye clinic is they chart half online and half on paper. This means once the physician is done with the chart I have to enter the paper chart in the computer. Once I enter it, the ophthalmology tech goes through the information and edits it depending on what the physicians tells her. So what could have been one step quickly turned into three steps and a lot of wasted time. It’s very frustrating because having a paper chart, and an EMR defeats the purpose of having electronic medical records. 

Last week I learned that the eye clinic where I work is going to stop implementing the use of EMR’s and pay a yearly fine once 2014 rolls around because it would be cheaper for them to pay the fine than buy new equipment and train staff. I couldn’t find online how much the fine is but one has to wonder how many other facilities will just pay the fine instead of converting. 

Overall, I think the mandate is a bad idea because it forces facilities to convert to EMR’s that may not be ready to implement electronic charts. I think it rushes training and this could lead to critical chart errors. Money is also another huge factor; it’s not cheap to get a brand new computer system and equipment. For smaller facilities this could be a huge financial challenge. I think the government is already too involved in healthcare and they need to stay out. Unless universal healthcare is implemented I don’t think that the government should be telling medical facilities how they need to have their medical records.