EMR systems pose some challenges

June 1, 2005

The world of electronic medical records (EMRs) may seem daunting as ophthalmologists try to determine the best way to apply emerging technology to medicine.

For those doctors who like to tinker with the newest technology, there are plenty of reasons to invest in an EMR system. But for those who are a little more hesitant, there are just as many reasons to wait, according to Arnold S. Prywes, MD, an ophthalmologist in Beth Page, NY, who spoke at the American Academy of Ophthalmology annual meeting last year.

In a talk that was both entertaining and informative, Dr. Prywes intertwined familiar movie and television clips with the pros and cons of EMR.

"A keyboard used to be a piano. A web was somewhere a spider lived. A virus was flu, a hard drive was a long trip on the road. And if you had a 3 1/2-inch floppy, you probably didn't tell anybody about it."

Four types of systems EMR refers to four types of systems, with varying abilities, complexities, and costs.

Dr. Prywes outlined several reasons why doctors might consider investing in an EMR system, ranging from complying with mandates "from up above" (including the government), to avoiding errors caused by sloppy handwriting, to improving billing and claims procedures.

"So why wouldn't we want to do this?" he asked. "It is cool, it is Star Trekkian, it is like motherhood and apple pie," if you believe the hype. But there are reasons to be cautious, he warned.

For example, EMR systems are expensive-costing from $50,000 to $150,000-or more, for a larger practice-plus 10% to 15% of that to maintain them. They also require training and a learning curve. And, he noted, if someone accidentally deletes one's files, one will need information technology help.

Suited for large practices In many ways, he said, EMR systems are better suited for large, broad medical practices, because the vocabulary and other details are not as well established for smaller specialities like ophthalmology. The large companies making EMR systems aren't investing in systems specific to ophthalmology, and some of the smaller companies who have are no longer in business.

"If you get stuck with a glitch, you are in a bad situation," he said. "You'll have to go look for that paper record, which you no longer have."

Despite its drawbacks, the technologically savvy physicians may be intrigued enough by EMR to put up with a few glitches and might discover a more efficient way to practice.