Advantages and Disadvantages

of EMR Systems

EMRs, or electronic medical records, play a critical role in how healthcare

practitioners store medical records, provide treatment and manage finances.
The benefits of EMR software also extend beyond quality patient care
through incentive programs for healthcare organizations. They’re especially
important to single practice facilities and family physicians who aren’t
necessarily sharing patient records across disciplines on a regular basis.

Some of the first medical records date back to Hippocrates in the 5th century
BC and medieval physicians. Formal medical records appeared in the
nineteenth century in Europe in major teaching hospitals and were quickly
adopted across the world. The modern medical record was developed in the
20th century – data about each patient, including clinical data, was recorded,
organized in a standardized format and stored. Major problems with
traditional paper medical records include lack of standardization across
physicians and healthcare facilities, poor searchability and loss of
information.

EMR has been in evolution for several decades now but continues to grossly
miss the intended mark of efficient and personalized patient care. The first
EMR was developed in 1972 by the Regenstreif Institute in the United States
and was then welcomed as a major advancement in medical practice. The
uptake, however, was low, the cost being a major constraint. The vital push
came through the American Recovery and Reinvestment Act 2009,
spearheaded by Barack Obama, which envisaged incentives to EMR users.
Several EMR packages have since been developed and have become widely
available across the world.

Benefits and Advantages

The benefits and advantages of electronic medical records are two-pronged:
they are beneficial for both patients and clinics. Let’s take a look at them
below:

1
For Patients:

 Fewer errors compared to paper records.

 Better and quicker care.
 Track results and data over time.
 Improve treatment and diagnosis.
 Identify patients who require screenings and preventive care.
 Better patient health data security and privacy.
 Supports data-based decisions.
 Receive follow-up support like reminders, weblinks and self-care
suggestions.
 Patients can access their records, view prescriptions and follow
recommended lifestyle changes.

For Clinics:

 Save Space: Clinics don’t need to store, manage and retrieve paper
records, thus saving space.
 Optimize Workflows: EMR help optimize workflows, keep track of
patients and manage patients who visit the medical facility.
 Lower Operational Costs: They reduce operational costs by keeping
records in one place.
 Contact Other Medical Facilities: Clinics can interface with
laboratories, pharmacies, hospitals and state and national health
systems.
 Scalable: They help customize and scale patient records.
 Enables Outreach: Clinics can gather patient data and analyze it.
This accessibility helps providers reach discrete populations, improving
overall health.
 Reminders: EMR have communication capabilities that let clinics send
reminders and alerts.
 Documentation: They reduce errors during documentation, improving
care.
 Supports Research: Documenting patient records digitally supports
research, and users can monitor patients for better care quality.
 Checks Conflicting Treatments: They have safeguards that prevent
treatments that may conflict with each other.
 Communication Between Staff: They track messages between staff,
hospitals, labs and other clinicians.
 Avoid Duplicate Tests: Without timely access to test results,
physicians may have to order repeat tests. Keeping physicians up-to-
date on previous tests reduces the need for repeats. It is especially
important when tests are expensive, uncomfortable and invasive.
 Links to Other Health Information: EMR connect to public health
records like communicable diseases and other health registries.

2
EMR record information and leverage it to help clinics meet their business
goals. For example, they check prescribed medications for conflicts with
health conditions and other medications. Unlike paper records, they can also
identify and help prevent operational issues.

EMR is considered potentially one of the drivers for the transformation of

healthcare. From a patient care perspective, EMR is expected to improve the
accuracy of the information, support clinical decision-making and improve
the accessibility of information for continuity of care. From an operational
perspective, EMR should generate essential health care statistics crucial to
the planning and management of health care services. User expectations
from a good EMR are several – meticulous patient documentation, common
templates and order sets, disease coding and billing, regulatory compliance,
prevention of medication errors, clinical pathway utilization, optimized
workflow, medico-legal defensibility, adaptive learning capability, simplicity,
multiple input interfaces (notes, voice transcription, drawings, etc),
incorporation of clinical images, seamless connectivity with clinical
investigation platforms, input speed at the point of entry, and most
importantly, data compilation for analysis and research, all with time-
efficiency, and a user- and patient-friendly interface. Ideally, EMR should be
on a single platform nationwide to enable interoperability and portability
horizontally and vertically across the referral chain.

Are computers and clinicians uneasy bedfellows? Probably not. Every sphere
of life, including the practice of medicine, has seen extensive
computerization and the present generation of doctors are extremely
comfortable with digital technology. The uptake of EMR is on the rise and it is
here to stay. In the United States, ophthalmologists have almost quadrupled
their EMR use, from 19% in 2008 to 72% in 2016. The use of EMR is still in its
infancy in India.[8] The Government of India intends to introduce a uniform
system of EMR. An expert committee set up by the government has
developed “Electronic Health Record Standards for India”. With this as the
background, there is an immense nascent potential for EMR in India. With
major Indian ophthalmic institutes having developed their EMRs and using
them in their routine daily practice, and their residents and fellows having
been “trained on EMRs”, its use is only likely to increase.

Beyond providing better care and improved systems, using these systems,
the benefits of EMR software extend to financial improvement. They reduce
overtime expenses and operational expenses over time, reducing the
financial burden on medical facilities. Better patient care and efficient billing
processes also add to the bottom line.

3
Department of Health Care, Organization and Policy, University of Alabama
at Birmingham published a paper in 2014 stating that researchers have
examined the benefits of EHRs by considering clinical, organizational, and
societal outcomes. Clinical outcomes include improvements in the quality of
care, a reduction in medical errors, and other improvements in patient-level
measures that describe the appropriateness of care. Organizational
outcomes, on the other hand, have included such items as financial and
operational performance, as well as satisfaction among patients and
clinicians who use EHRs. Lastly, societal outcomes include being better able
to conduct research and achieving improved population health.

Disadvantages
The disadvantages of EMR are not within the systems themselves. Rather,
the initial investment, implementation and training to use them. Since their
implementation is customized according to each clinic’s requirements, every
implementation comes with its own timeline and challenges. Typically, the
software vendor appoints a specialist who guides clinicians through the
entire implementation cycle. Other possible disadvantages include:

 Prone to Hacking: While digital records are safer and more secure
than maintaining physical papers, data breaches have become
common. Certified systems have built-in security measures that
protect patient data, but the clinic’s staff need training to maintain
basic security measures. For example, leaving workstations
unattended may leave them open to unauthorized access.
 Require Updates: Other supporting medical professionals like
pharmacists and personal trainers may use the same health record
system, and it becomes imperative to update records after every
appointment. If records are not updated frequently, they may
adversely affect treatment due to inaccurate data.
 Device Management: Not being able to access devices because of
location, power cuts or no internet may disrupt patient care, diagnosis
and treatment. Physicians may even forget to carry their devices
during rounds, creating gaps in records.

It’s hard to ignore the shortcomings of these platforms. However, you can
overcome them by implementing proper workflows and training providers
and support staff.

The chief complaint against EMR is that it has undermined personalized face-
to-face patient care and the vital doctor-patient interaction - the very soul of
medicine - into a new check box-based doctor-computer-patient interaction.
Abraham Verghese calls this an “iPatient” phenomenon. EMR was never
designed to facilitate a personalized human narrative, logical thinking, and

4
experience-based clinical analysis. Clinical reasoning being the backbone of
a traditional doctor-patient interaction, “a medical record—whether paper or
digital—must preserve the information that the physician carefully and
thoughtfully elicits from the patient in a form that, above all, facilitates
clinical reasoning.” Current EMRs do not.

A new report from the National Academy of Medicine is revealing – on an

average, nurses and doctors spend 50 percent of their workday treating the
screen, not the patient, and the increased work burden associated with EMRs
is one of the factors for physician burnout. A study of emergency room
doctors revealed that putting information into the computer consumed more
of their time than any other activity. Using a “click” of the computer mouse
as the standard of measure, a doctor needed to make 6 clicks of the mouse
to order an aspirin, 8 clicks to get a chest x-ray, 15 clicks to provide a
prescription, etc., Over 40% of a typical 10-hour emergency room shift was
devoted to data entry and 4,000 clicks of the computer mouse. Immense
information on EMR results in high (data) noise to (clinical) signals ratio.
Arnold Relman, former editor-in-chief of the New England Journal of
Medicine and a physician with 6 decades of experience found EMR “lacking
in coherent descriptions of his medical progress, or his complaints and state
of mind” when he was a patient himself.

Despite the growing literature on benefits of various EHR functionalities,

some authors have identified potential disadvantages associated with this
technology. These include financial issues, changes in workflow, temporary
loss of productivity associated with EHR adoption, privacy and security
concerns, and several unintended consequences.

Financial issues, including adoption and implementation costs, ongoing

maintenance costs, loss of revenue associated with temporary loss of
productivity, and declines in revenue, present a disincentive for hospitals
and physicians to adopt and implement an EHR.

Will We Ever Find the Gold? - Can there be a

Perfect EMR?
As there can never be a perfect spouse, there can never be a perfect EMR.
EMRs must evolve and the potential users synchronously need to retrain
themselves and change their mindset until a sweet spot is reached. “To
develop an EMR that meets the needs of the physicians who will use it, we

5
need to better understand how the physicians work, and develop the
software with an eye toward solving real problems in practices rather than
developing a solution looking for a problem.”[12] Fortunately, India seems to
be leading in the development of stand-alone ophthalmology EMRs, and that
too with significant contributions from the users' right at the stage of EMR
development. Sankara Nethralaya and Tata Consultancy Services (TCS) have
together developed a comprehensive EMR system from scratch. It is natural
for people to forget, but Anthony Vipin Das must remember that it took us a
lot of effort to initiate and carry forward an in-house coding and development
of EMR at the LV Prasad Eye Institute (LVPEI) about 10 years ago. It was
meant to be a smart EMR, developed by the ophthalmologists and for the
ophthalmologists, appropriately called eyeSmart. I feel redeemed that the
seed that I had a small part is sowing and initially nurturing has now grown
to be a fruit-bearing tree and is seamlessly used across the LVPEI network for
patient care, administration and research. The current issue of the Indian
Journal of Ophthalmology carries an article from the LVPEI group reporting
their 8-year experience with eyeSmart and the accompanying commentary
puts things in perspective.[13,14]

Robert Wachter states in his book The Digital Doctor – ”One of the great
challenges in healthcare technology is that medicine is at once an enormous
business and an exquisitely human endeavor; it requires the ruthless
efficiency of the modern manufacturing plant and the gentle hand-holding of
the parish priest; it is about science, but also about art; it is eminently
quantifiable and yet stubbornly not.” An ideal EMR should harmoniously
bring together the soul of medicine and cutting-edge informatics.