Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A plea for a universal, unified EMR

James C. Salwitz, MD
Tech
April 29, 2013
Share
Tweet
Share

At some point, this gets to be ridiculous. Online, I can buy any item from anywhere at any price, pay any bill, watch any movie, listen to any song, order dinner, schedule car repair or read about any subject on Wikipedia.  I can determine the weather in Rio, sport scores of Barcelona, Parisian traffic or by GPS the location of my kids, just down the block.

However, I absolutely cannot learn anything at all of the health history of the flesh and blood cancer patient sitting right in front of me.

Today, I am seeing long-term patient, Thomas R.  Father of three and a really nice guy, Tom is a medical challenge.  He is immunocompromised and status post 20 years of complex chemotherapy, radiotherapy, a bone marrow transplant and several bizarre complications, we barely understand.  In the last two months, since his last visit with me, he has seen an internist, a dermatologist, a podiatrist, a neurologist, a dentist and an infectious disease specialist.  These doctors ordered X-rays, lab tests, blood cultures, an EMG, a skin biopsy and several new medicines.   These are confusing tests resulting in confusing diagnoses with confusing therapy in a confusing patient. What records do I have of all this new complexity? Nada. None.  Moreover, based on our files, all these other physicians have none of ours.

Yesterday I saw Ellen T.   This highly intelligent woman was previously in excellent health, but two years ago she suffered devastating hematological complications of routine surgery.  She presently takes 21 different medicines from a laundry list of specialists, including several surgeons, kidney specialist, physiatrist, rheumatology, gastroenterology, cardiology and endocrinology.  On January 1, 2013, two things went wrong.  First, her blood sugars skyrocketed dangerously and remain over 300.  Second, she changed her health insurance and most of her doctors do not participate in the new plan.  She needs to immediately transfer her records and establish a new care team. Do we have a copy of all this information from all these locations?  Not at all.

Bob M. dropped by the office to get a lab test after four months of chemotherapy.  A tooth is causing pain, and it needs to come out.  His dentist sent a note asking whether Bob should stop taking his blood thinner.   Our records have no mention of any blood thinner.  Bob never told us, because his primary care doctor has been prescribing and adjusting that unstable medication.  We shudder at the thought of how the blood thinner interacted with the chemo.

Would you go to a bank that required you to carry a paper ledger of all your deposited money if you moved from one branch to another?  Would you fly a commercial airline whose arrival at its destination airport was always a surprise?  Shop at a supermarket with unlabeled aisles, food piled in bins, and secret prices that had to be looked up, one item as a time, when you checked out?  We continue to tolerate a health care system where our personal information is kept locked in unconnected, non-communicating silos, so that every time we see a new practitioner we have to start again and the only thing that protects us from disaster is our own memory of our medical past.  The result is duplication, error and instead of treating each patient based on their health history, doctors must guess about the best care, without knowing its possible impact.

Our entire medical histories, drug lists, allergies and complaints should be securely stored in an accessible common file much like Facebook, bank accounts or Amazon. Each of these maintains a master file on us, which can serve as a model.  With our permission, doctors, pharmacists, nurses, podiatrists, chiropractors, hospitals and even nursing homes, should have easy, secure, on-line access.  When you see a new caregiver, they should open this master file to understand who you are and, critically, record new diagnoses and treatments in that common electronic vault.  A unified, universal electronic medical record (EMR) should be the foundation of health prevention and therapy, and not be some holy grail we never seem to reach.

There remain significant hurdles to reach this critical goal. We must push the techies to solve the obstacles to full universal EMR implementation, which include the challenge of data input, the rules for internal organization (what does the e-chart look like?), a national backbone and vital security.  We must insist that health providers fully commit to this core project. Finally, we must allocate needed dollars to build this vital part of our infrastructure.

Will a universal EMR save dollars?  Not right away, but in the near future, absolutely.  Will it improve the safety, quality and efficiency of medical care and thereby save lives.  Definitely.  Is there any reason to maintain our system of primitive individual medical isolation?   None at all, continued delay would be ridiculous.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Prev

That slippery bowel wants to be everywhere

April 29, 2013 Kevin 2
…
Next

The KevinMD toolkit: Blogging

April 29, 2013 Kevin 6
…

Tagged as: Health IT, Oncology/Hematology

Post navigation

< Previous Post
That slippery bowel wants to be everywhere
Next Post >
The KevinMD toolkit: Blogging

ADVERTISEMENT

More by James C. Salwitz, MD

  • Each line on the radiology list is a patient’s line in the sand

    James C. Salwitz, MD
  • The broader mission for hospice care

    James C. Salwitz, MD
  • Is the medical profession at its end?

    James C. Salwitz, MD

More in Tech

  • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

    Harvey Castro, MD, MBA
  • AI is already replacing doctors—just not how you think

    Bhargav Raman, MD, MBA
  • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

    Shanice Spence-Miller, MD
  • How digital tools are reshaping the doctor-patient relationship

    Vineet Vishwanath
  • The promise and perils of AI in health care: Why we need better testing standards

    Max Rollwage, PhD
  • 3 tips for using AI medical scribes to save time charting

    Erica Dorn, FNP
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 25 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why the heart of medicine is more than science

      Ryan Nadelson, MD | Physician
    • How Ukrainian doctors kept diabetes care alive during the war

      Dr. Daryna Bahriy | Physician
    • Why Grok 4 could be the next leap for HIPAA-compliant clinical AI

      Harvey Castro, MD, MBA | Tech
    • How women physicians can go from burnout to thriving

      Diane W. Shannon, MD, MPH | Physician
    • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

      William J. Bannon IV | Conditions
    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A plea for a universal, unified EMR
25 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...