It’s that time of year again. Like my mother, I’ve taken to scheduling any sort of annual event around the time of my birthday. So, now my birthday cake is accompanied by a trip to get my emissions done, a jaunt to the tag office, and a visit to my primary care doctor for an annual physical and any other female-related health services I might need. (Timely, considering that October is also Breast Cancer Awareness Month.)
I tend not to schedule my well visits months in advance, and so was a bit apprehensive earlier in the week as I dialed in to get an appointment. I’ve read quite a few patient horror stories lately of appointments not being available for months due to lack of staff. Thankfully, this was not my experience. I was able to pick the date and time of my choosing, with the only insurance-related caveat being that I had to wait until one day after the date of my exam in 2011.
When I was at the doctor’s office last year, they were in the process of launching a patient portal. Digging around on their website while speaking with their receptionist, I noticed the portal is indeed available. The patient-centric portal offers online bill pay, appointment scheduling and pre-registration services and a personal health record. I’ll be interested to see if they mention its availability when I am seen in a few weeks. I’ll definitely ask who was involved with the implementation, and if they’re looking to Stage 2 Meaningful Use quotas when it comes to electronic patient engagement.
But enough about me. The reason I bring all this up is because the Journal of the American Medical Informatics Association recently made available research on “The effect of electronic medical record system sophistication on preventive healthcare for women.” A quick look at the abstract relates that 29.23% of providers (culled from those in the National Ambulatory Medical Care Survey from 2007-08) had no EMR system, 49.43% had minimal EMRs, 15.97% had basic EMRS, and 5.46% had fully functional EMRs.
“For breast examinations, pelvic examinations, pap tests, Chlamydia tests, cholesterol tests, mammograms, and bone mineral density tests, an EMR system increased the number of these tests and examinations,” according to the abstract. “Furthermore, the level of sophistication increased the number of breast examinations and pap, Chlamydia, cholesterol and BMD tests.”
The JAMIA’s point being that “the use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women’s health should consider investing in more sophisticated systems.”
I’m going to play devil’s advocate here for a minute.
First of all, the fact that not even 5.5% of providers surveyed had a fully functional EMR is dismaying, but perhaps I don’t understand the underlying financial reasons for their lack of adoption. And the fact that the survey was taken more than four years ago could play a part. It would seem to me that there would be much to gain clinically and financially in having a fully function EMR especially in obstetrics, where women are often seen at a number of facilities throughout their pregnancies.
And finally, I have to take issue with the “positive results” the JAMIA concludes the study to have had. To me, “positive” connotes “successful,” so I wonder if there’s a hidden conflict of interest here. Increased sophistication of EMR systems would seem to equal more tests, according to the study, but no mention is made of if those tests lead to better outcomes (a win for patients) or higher reimbursements (a win for providers). I know we walk a fine line when talking about EMRs, tests and money, and that it often ends up being a chicken-and-egg situation, but it’s still a debate that needs to be had, especially in the area of women’s health.