Over the past several months I have read several online discussions and comment threads on the medical-legal issues raised by EMR, including an HIMSS brochure on the subject.  Most of these discussions miss what I consider to be the most important legal weaknesses of an electronic medical record. I finally came across an online discussion that comes closer to covering what I consider to be the most important ...

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The interaction of humans and technology will always be unpredictable.  A few months ago this thought was driven home to me in a rather malodorous manner. I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably.  With OSA your airway collapses when you fall asleep.  A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a ...

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A fair amount has been written on EMR for the individual physician facing retirement. But I have come across a more complicated variation of the question.  What if a multi-physician group has one physician approaching retirement who is the "lone hold-out," opposing EMR while the rest of the docs in the group are ready to take the plunge? The older physician has a ...

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In 2003 our practice had a rare opportunity to build EMR functionality into the floor plan of our new office.  I thought I had the perfect design for the EMR-based exam room. The spring-loaded, cantilevered arms used to hold monitors and keyboards in ICU rooms would be perfect.  Fitting a touch screen monitor to a standard PC would allow the provider to work without a mouse.  I could turn the screen ...

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The recent financial incentives offered by the government (HITECH) for EMR implementation are somewhat helpful but are also misleading. Most fail to recognize that the biggest obstacles to EMR implementation are not financial, but are cultural.  EMR adoption will require cooperation between two disparate cultures:  the Health IT (HIT) culture and the medical culture.  One needs only to read a few of the EMR debates in any health care blog to ...

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Some of the toughest obstacles to EMR are the physician doubters. These people say, “My charts are going to be on a computer.  So what?  All I know for sure is that it will take longer for me to finish my charts every day and we will have another component in fixed overhead.  Why this is a good idea?” The concerns are valid.  When my practice chose to get EMR 6 years ...

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After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real. If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices?  Why is there so much resistance?  As folks who work in heath care IT so often ask, why don’t doctors “get it?”  I don’t ...

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