You can make a partial transition to e-records


“Is it time for electronic medical records in your practice?” by G. William Bates, MD, MBA and “Do electronic medical records make for a better practice?” a roundtable discussion moderated by G. William Bates, MD, MBA

Dr. Bates presented an educational and seasoned overview of electronic medical records (EMR)—words of wisdom that should certainly be read by all clinicians contemplating use of EMR. However, Dr. Bates and the panelists for his roundtable discussion took an all-or-none approach to EMR implementation, suggesting that a practice has only two choices:

  • Implement a comprehensive, paperless EMR and patient-management system that may cost many tens or hundreds of thousands of dollars and can potentially disrupt every aspect of a practice or organization
  • Stick with paper records and forfeit all of the economic and clinical value of EMR.

I would like to propose a third option: graduated implementation of EMR in a single area of ObGyn practice—an area where access to clinical records matters most—making EMR more palatable to technology-wary, litigation-averse, and financially strapped clinicians. Obstetrics lends itself perfectly to an exchange of paper prenatal records for always-accessible electronic prenatal records.

Such limited implementation, at a fraction of the cost of comprehensive EMR, can provide immediate and obvious clinical value with little change to workflows set up with paper prenatal records in mind. This pragmatic stepwise approach to digital care may be especially useful in practices populated by one or more clinicians who are resistant to overwhelming leaps but can tolerate sensible smaller steps.

Donald W. Miller Jr, MD
Founder and CEO, eNatal
Shawnee, Kan

Dr. Bates responds: Incremental adoption is not yet practical

Five years ago, I would have agreed with Dr. Miller about incremental adoption of EMR. In fact, I, too, advocated such an approach. However, I quickly learned that physicians want a system that will provide electronic management of most—if not all—aspects of their practice. Otherwise, they will “wait and see” rather than adopt EMR. I think the evolution of EMR feature development has delayed adoption of EMR.

The problem with incremental adoption of EMR is the variation in documentation that it creates in a practice using a conventional paper-based system. Physicians and their staff have to remember to perform certain functions in the EMR and others on paper. This bifurcation of systems creates dysfunction in process and progress. Moreover, any system that enables incremental adoption must have the functionality to become a comprehensive EMR or be integrated into a comprehensive EMR. Universal interoperability of systems is a goal of EMR users and vendors, but remains just that—a goal. When that goal is realized, incremental adoption of disparate systems may become reality.

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