I work as a programmer for a company that makes electronic medical record (EMR) software. Normally I don't talk about it here, because I don't want it to seem as if I'm speaking for my employer, but I commented recently on another diary and the author asked me to diary it, so, here goes.

I want to emphasize that what follows is my opinion and I don't speak for anyone else. Where I avoid going into specifics, it's to ensure that I don't accidentally mention anything that's not public information. With that said, follow me over the fold..

One misperception seems to be that medical software is made deliberately hard to use and overpriced; before I refute that, let me talk a little about what EMR software does and why we use it.

The field isn't new - EMR software has been around since at least the 70s. The primary reason for using it is obvious: paper charts are inefficient! Only one person can look at the chart at a time, it has to be moved around to the correct location, and it's full of doctor's handwriting. One time the doctor's office even pulled out the wrong chart for me (they mixed me up with my dad, who has the same name). In contrast, an electronic medical record can be viewed by several people at once, in different locations, and is generally more legible. It can warn you if there are several patients with the same name. It's also easier to pull together exactly the information you're looking for rather than having to dig through potentially years of old notes.

These days, of course, EMR software does a lot more than that. Computerized order entry (CPOE) reduces the number of errors by making sure the order is legible and helping the doctor to select the correct option. Automated checks call the doctor's attention to potentially fatal drug interactions and allergies. Suggested order sets help medical personal avoid forgetting any tests or treatments they might want to order. All of this helps prevent mistakes and avoids negative patient outcomes.

Making this software easy to use is a high priority, but making it safe takes precedence. The diary that lead to this one was comparing medical software to video games (which look a lot slicker), but if a video game has a bug, the company can release a patch. If medical software has a bug, people could die. As a result, a lot of testing goes into every change and new development (at my company, multiple people will look at every change I make, including several programmers) to ensure patient safety. (I don't know much about computer games, but I'm guessing that most of them don't have literally hundreds of programmers working for years on each update!) Not only does the software have to work perfectly, with hundreds or thousands of simultaneous users working with terabytes of data, but it has to work differently for different specialties; a neurosurgeon should not see the same screens as a podiatrist!

Although using EMR software saves both money and lives in the long run, due to the amount of effort that goes into putting it together it does represent a significant up-front investment. (For a large hospital system purchasing a full software suite, the cost can be eight figures).  The effort put in to learn a new system can often be substantial, and many doctors resent the time it takes when "the old way worked just fine!" Yet, doctors with experience using EMRs appreciate the software because it leads to improved outcomes for patients.

Under the meaningful use standards put out by the federal government, doctors and hospitals are now required to make "meaningful use" of EMR technology. This is backed up by a change in Medicare reimbursement; if you report that you're successfully using EMR technology now, you get extra payments. Each year, the amount of extra money you get drops and the requirements (for example, the percentage of your physicians who are using CPOE or the percentage of your diabetic patients who are on a monitoring plan) increase; in a few years, not meeting the meaningful use requirements will mean a decrease in Medicare reimbursement. The expectation is that the carrot of extra money now and the stick of less money later will combine to give medical providers the push they need to start using modern systems, which ultimately reduce costs and save lives.

Originally posted to wmspringer on Sat Feb 25, 2012 at 01:12 PM PST.

Also republished by Community Spotlight.

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