It has now been almost a full year since I started using the EMR. I am starting to get some good cumulative data for individual patients. I am also learning to search for conditions in my whole practice, by using clinical reports.
This ability to search is essentially not available in paper records, and is a major benefit of EMR. Here is what I can search for:
I can also search by gender, and by age ranges. These searches can be combined by using boolean terms (and, or, not). The Report feature is fairly user-friendly, once you've worked with it a couple of times. The search query terms can be saved and reused, and I've used my saved searches to see how I am doing over time.
The Report feature is still limited, since I cannot search for lab results (example, give me all patients with cardiovascular disease AND LDL >2.0), or vital signs (all diabetics with BP>130/80). As well, I get a list of patients, but not the number of patients; I got around that by importing the file into excel and manipulating the data.
This brings up an interesting problem: we can save data to local machines (as I just did). The Hospital for Sick Children was recently severely criticised for losing some personal health data: a researcher took a laptop with patient data home, and the laptop was stolen from his car. Security for the EMR is very tight, especially for remotely hosted applications; however, this does not apply to data downloaded to my Tablet. I put passwords on Excel files, but I don't know if that is enough; I'm not sure what we should do for what is going to be an increasingly common issue. There will need to be a balance between data encryption to protect privacy, and the need to access files. Perhaps we should look at a large purchase of data encryption software for all physicians, rather than leave individuals to fund and buy this individually. I'm pretty sure Sickkids does not make each research buy the software themselves.
In a recent editorial in the New England Journal of Medicine (Performance Measurement in Search of a Path, Dr Hayward, March 1 2007), the author noted that "Perhaps our greatest barrier to developing a worthwhile performance-measurement system is our unwillingness to invest in it." He notes that the Department of Veteran's Affairs, a world leader in quality, does detailed reviews of electronic medical records. I think it is now possible to do this with current EMRs; we need to invest in data reporting, and target priority conditions. What you don't measure, you can't improve.
These are recent reports I've run: