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Publication Briefs

JAMA Commentary Discusses Federal Investment in Electronic Medical Records


  • The American Recovery and Reinvestment Act (ARRA) includes $19 billion in incentives for the adoption of electronic medical records (EMRs) and $50 billion to promote health information technology. Medicare physicians adopting and making "meaningful use" of EMRs in 2011 and 2012 will be eligible for an initial payment of up to $18,000, with reduced payments in 2013 and 2014.
  • Most current EMR systems simply 'digitize paper.' That is, they document and facilitate communication of individual patient conditions and treatments between clinicians, justify financial reimbursements, and provide legal records of events. Few, however, incorporate methodology for learning from aggregated health data to improve quality of care. The author suggests that the Department of Health and Human Services capitalize on the opportunity to mandate EMRs that have the potential to learn from data in the EMR system.
  • EMR databases that currently contain information such as vital signs, images, laboratory values, demographics, etc., can be mined for new knowledge. Thus, best clinical practices can be discovered based on the analysis of entire populations.
  • Networking these databases increases the power to improve healthcare exponentially.
  • The eventual addition of genomic information, environmental factors, and family history to these databases will enable clinicians to begin to realize the potential of personalized medicine.
  • Interfaces and workflows in EMR systems must be flexible enough to capture new information at the point-of-care — and to put lessons learned into action.
  • Data governance policies must be implemented that recognize that protecting patient privacy and learning from aggregated data are not mutually exclusive activities.
  • The Veterans Health Administration has demonstrated that EMR data can be meaningfully used to improve health care.

Few would disagree that upgrading the information infrastructure of hospitals and clinics is essential to improving the quality of healthcare; however, today's EMR systems are not designed to enhance this process. Current EMR systems' inability to learn from aggregated health data has led to implementations and hospital information technology departments that can actually obstruct quality improvement. For example, much of the information contained in EMRs is formatted as unstructured free text — useful for essential individual communication but unsuitable for detecting quantifiable trends. As part of the ARRA's provision for HIT, the US Department of Health and Human Services has until December 2009 to define the "meaningful use" of EMRs.

Dr. D'Avolio is with the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), part of the VA Boston Healthcare System.

PubMed Logo D’Avolio, L. Electronic Medical Records at a Crossroads: Impetus for Change or Missed Opportunity? “Commentary,” JAMA September 9, 2009;302(10):1109-1111.

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