Do electronic medical records improve quality of care?

I would like to comment regarding the recent Debate between Dr D P Manca and Dr M Greiver "Do electronic medical records improve the quality of care?" and also regarding the related Editorial by Dr Roger Ladouceur (Associate Scientific Editor) "What if electronic medical records were unnecessary?".

I think all would agree that EMRs were promoted and funded with expectation that improvement of quality of care would follow. I have not reviewed the literature but I am sure that the jury is still out on this; to measure improvement in quality of care related to use or not use of EMR versus paper charts must be highly complex i.e. beyond complicated.

Quality of care is potentially affected as EMR use touches on a huge range of factors and variables. I would also say that EMR systems and EMR use is still immature and over time is likely to become much more sophisticated.

However, the main point I want to make is that my work as a GP is so much more pleasant than when we still had paper charts. I hated paper charts. I do not write very legibly and it will be no surprise if I say that numerous other physicians have the same problem. I can honestly say that I cannot read about 20% of what is written by others in charts and reports (some ER or hospital progress notes are virtually 100% illegible) - a real quality-of-care worry if one cannot read what another physician had to say about a shared patient. It is such a relief to be able to read typed reports and I feel so much happier at the end of the day - every word I "wrote" is legible (and can be inserted into a referral letter or report).

Also, it was always a struggle to find lab reports, DI reports, consult reports etc in 1-3 inch thick paper charts. They got out of chronological order etc. Now at a click or two I can find any report within seconds 99% of the time. And I can view cumulative values etc. I think that the debate should have addressed these types of issues as well. Dr Manca ably described how the EMR enables such tasks and functions.

With regard to the editorial, Dr Ladouceur describes research reports related to quality of care outcomes. He then goes on to say that "there is a strong likelihood that EMRs compromise doctor-patient communication" but does not provide any scientific evidence to support what is basically his opinion. I cannot speak for other FPs but I believe this is a non-issue. I type all my notes while the patient is with me in the office and a lot of talking and listening happens while I am doing this. I often double check certain points in the history to clarify and the EMR allows me to insert or change content. I think patients appreciate this. Also, there is much time for eye-to-eye communication when I examine the patient or discuss clinical impressions and management plans. Whether you type or write, you are not making eye contact. If patient physician communication is poor, then I do not think one should blame the EMR.

A final point, I think Health Authorities should continue to provide GPs with Health Information Technology support workers to help GPs reach higher levels of EMR competency. It is too early to step away from this role. Many GPs are still learning or are stuck at a low level of use. I think ongoing training to reach higher levels of sophistication in use will be necessary for some years yet. Such ongoing interaction with IT workers should also support improvements in EMR functionality.

Conflict of Interest:

None declared