Letters to the Editor - Nov. 8, 2004

EMR goal should go beyond practice aid to extensive tool for patient care - Make VA electronic medical record systems available to all physicians - Doctors should respect the demands put on nurses' time and attention

EMR goal should go beyond practice aid to extensive tool for patient care

Regarding "Should I buy my EMR now?" (Article, Oct. 11): I enjoyed your timely article about the cautions of electronic medical record adoption. However, the true power of EMRs is not to run my practice, but to allow the establishment of a patient-focused, community-based, longitudinal health record.

We need to raise our sights to recognize the fundamental change in medical record keeping. The record is no longer simply a memory aid for me to remember my last encounter with a patient; it is a tool that reflects the patient's current health state, is owned by the patient and is contributed to by all caregivers. It is a tool that encompasses ordering and resulting, physician-to-physician communication, access to best-practice knowledge bases and patient participation in their care, as well as practice management functionality, scheduling and account management.

The question that practices should be asking is not "Which EMR should I buy?" but "How can I help create a local environment which will allow such a vision?" This involves some surrogate for "community," usually a hospital, to place a stake in the ground declaring a local standard (becoming the "information hotel," analogous to its role as a health care hotel) and facilitating participation in an enterprise utility.

Physicians will adopt this model when it makes their lives "better, faster, easier," becomes the source of patient information and becomes the expected community standard. This model can be made to work, but its broad acceptance requires regulatory change to allow hospitals and physicians to work together.

It requires that the beneficiaries of this change help to finance it (payers, patients, government regulatory/reporting bodies.) It also requires us to overcome concerns about competitive advantage.

We are all in the same business of caring for our community. It's time to recognize that our communities will benefit if we all work together.

--Arnold Wagner Jr., MD, Evanston, Ill.

Make VA electronic medical record systems available to all physicians

Regarding "Should I buy my EMR now?" (Article, Oct. 11): I have been following the topic of EMR systems over the past year and am surprised that there has been no mention of the electronic medical record system used by the Dept. of Veterans Affairs.

I had the privilege to work at one of the VA Medical Centers for one year and the pleasure of using their EMR system.

As a former computer systems specialist, I have found the VA system to be comprehensive, well-designed and easy to maintain and support. If the U.S. government is going to be mandating the use of EMRs, and they already have a proven product, why not make this product available for free (or at the cost of materials and distribution) to the practitioners?

This would ensure equal access to software, consistent development of the software over time, a supplier that will not go out of business, and interoperability between the practitioners and the country's largest health care provider, the government itself.

--Samuel L. Sharmat, MD, New York

Doctors should respect the demands put on nurses' time and attention

Regarding "Some doctors may lack manners, but also gone is the respect they once enjoyed" (Letters, Oct. 18):

I agree that certain support staff can be coarse to not only doctors but to nurses as well.

I also agree that nurses should have an open line of communication with the physician regarding the patient's medical condition and any other issues that may be affecting the patient's care.

However, nurses are not assigned to physicians; they are assigned to the patients. There are some instances that do not allow a nurse to be readily available to a physician at that physician's convenience. For example, when a nurse is assisting physician A with a procedure, the nurse cannot be available to consult with physician B regarding that doctor's patient, who may be more stable. Unfortunately, both physicians and nurses do not always have the opportunity to be everywhere all at once.

Finally, nurses do not go to school to bring physicians their coffee. Nurses are available to comfort the patient, educate the patient, give the patient their medication, turn the patient every two hours, suction the patient as needed, assess the patient and coordinate the patient's care. These are just a few of the actions that nurses do on a daily basis. Nurses are not there to deliver coffee to the physician, especially if it will take time away from their patient care. You can find coffee at the cafeteria or your nearest vending machine.

--Maureen L. Maloney-Poldek, RN, Schaumburg, Ill.