Large EMR's: The Back Story

I was surprised to see the backstory of EPIC Systems of Verona, WI, appear in the New York Times this morning. EPIC is one of the "biggie" electronic medical record systems that boasts 260 customers covering some 127 million patients' medical records by 2013. The article covers how the company was started and makes sure to mention the fact by Judith Faulkner, EPIC's CEO, that “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker.” (Seems like a glove was just thrown down to this reader.)

Still, Ms. Faulkner adds:

“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.

Balance? Hmmm.

So far, there appears to be huge skewing of information provided to health care administrators rather than doctors these days. For instance, when a doctor wants to know how many procedures their group has performed according to data they themselves entered into the Electronic Medical Record, they meet resistance. (This is not a small issue for doctors increasingly held accountable to MGMA benchmark productivity standards for their income.) Trust is a critical issue in medicine and doctors must feel they trust the data being given to them. The Electronic Medical Record systems of tomorrow should foster this kind of data transparency for doctors, not provide statistics from inaccessible data warehouses.

Doctors are eager to use their data for their patient's benefit. And yet they see these proprietary systems that carefully-control access to information as impediments to care rather than as facilitators of decision making. To date, this end-user still has yet to see any electronic data flow from one institution's EPIC data pool to another. Perhaps this capability will be realized some day, but for now, we still must request paper records from fellow EPIC institutions manually. While this limitation may be part of the "balance" to which Ms. Faulkner alludes, to doctors on the front line of care provision, this "balance" currently feels quite skewed away from patients and doctors.

Doctors are the largest and most influential contributors to the electronic medical record data and the cost of medicine. We see how these systems affect our patients first-hand. Unless change comes quickly to permit doctors to be involved in decisions based on the data they themselves provide the system, restricting their access to aggregated data assessment might become the greatest electronic medical error in the foreseeable future.

After all, how else will we ever be able to credibly challenge the potential for a critical programming or statistical error that could ultimately affect 127 million lives?

-Wes