A Proposal for Electronic Medical Records in U.S. Primary Care

Abstract

Delivery of excellent primary care-central to overall medical care-demands that providers have the necessary information when they give care. This paper, developed by the National Alliance for Primary Care Informatics, a collaborative group sponsored by a number of primary care societies, argues that providers' and patients' information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs). Although robust EMRs are now available, only about 5% of U.S. primary care providers use them. Recently, with only modest investments, Australia, New Zealand, and England have achieved major breakthroughs in implementing EMRs in primary care. Substantial benefits realizable through routine use of electronic medical records include improved quality, safety, and efficiency, along with increased ability to conduct education and research. Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S.

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

“…These include aiding patient self-management, 7 using reminder systems for evidence-based care, 1 engaging in performance measurement and feedback, 8,9 providing enhanced access to care, 10,11 and implementing electronic health records (EHRs). 1,12,13 This has occurred at a time when primary care is facing a number of challenges, 14 and for practices that do not already possess these capabilities, their implementation may require substantial financial investment. Recently, leading primary care professional societies have jointly issued a set of principles for a "Patient-Centered Medical Home" (PCMH).…”

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

“…8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the organization.…”

“…9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the organization. 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care practices and offer little or no patient care benefi ts.…”

Impact of an Evidence-Based Computerized Decision Support System on Primary Care Prescription Costs

“…Two systematic reviews found that a CDSS could improve other aspects of physician performance, such as medical error rates, drug dosing, diagnosis, laboratory test usage, and adherence to clinical guidelines. 5,6 Because most of these trials assessed internally developed, proprietary systems in hospital settings, there has been a call for research 6,7 This study was designed to evaluate the impact of a commercially available CDSS on the cost of medications prescribed by primary care clinicians in a community-based, ambulatory setting. The CDSS provides diagnosis-specifi c, evidence-based messages during the electronic prescribing process.…”