Electronic medical records | Globe Editorial

Like PC vs. Mac, but riskier

February 28, 2011

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DOCTORS NEED to know a patient’s medical history to provide effective care, but this isn’t easy in settings such as the emergency room, where time is short and patients may be physically unable to explain their medical history. This is one of the problems that electronic medical records ought to solve. But a big obstacle remains: the lack of so-called “interoperability’’ among electronic records created at different locations and with different software. Right now, the information doesn’t seamlessly transfer across institutions; an electronic record from one hospital may not be readable by a hospital across town. As in the early days of home computers, the variety of incompatible formats sows confusion and limits the usefulness of a promising technology.

A recent Archives of Internal Medicine article underscores the need to fix the problem. Researchers at Children’s Hospital Boston looked at all adult urgent care visits to 77 non-federal hospitals in Massachusetts between 2002 and 2007 — totaling over 12 million visits by 3.7 million patients — and found that one-third visited two or more hospitals during the study period; some 44,000 patients visited five or more.

The more patients jump from facility to facility, the less likely doctors are to get all the information they need. Some patients are particularly vulnerable: those who visited more than five hospitals were more likely to be mentally ill. These patients, who made an average of 12 visits to the emergency room in five years, take medications that have a higher risk of side effects and need to be tracked carefully.

Had the betterment of public health been the primary goal, hospitals would have developed electronic record systems that produced easily transferable information. But hospitals lack a strong incentive to adopt systems that, in theory, make it easier for a patient to seek care from a competitor.

But reducing the possibility of costly errors is to everyone’s benefit, and the federal government should use its influence to promote common standards. The Health Information Technology for Economic and Clinical Health (HITECH) Act is offering billions of dollars to encourage the adoption of electronic records, and one of the first goals must be to make sure all hospitals across the nation can seamlessly read and transmit electronic medical records from and to any source. Otherwise, this potentially transformational technology will simply create one more way for different health care providers to talk past each other.