Doctors’ documents: time to go digital

The traditional trip to the doctor’s surgery used to involve copious amounts of documentation. Before the medical practitioner could even begin to think about the patient’s symptoms, they would have to mull over a file full of paper records to familiarise themselves with the patient’s past history and earlier conditions. For a GP, who could be welcoming patient numbers of well into double figures during the working day, their desk would likely be a pile of these files.

This is hardly an ideal situation. Individual pieces of paper could be lost or placed in the wrong file, and if any of this information is handwritten, there is always the issue of legibility. Something vital could be misread, leading to an incorrect diagnosis.

Fortunately, patient information is increasingly being digitised via electronic medical record (EMR) and electronic health record (EHR) systems. Using a networked computer, the doctor can read the salient details about the patient, and enter any new symptoms or diagnoses straight into the database. With a tablet, this information can even be carried to a patient confined to a bed.

Although EMR and EHR are often used interchangeably, there are subtle differences between the two. An EMR will contain the medical and treatment history of a patient at a particular practice. This makes it easier to track data over time, such as keeping tabs on the scheduling of screenings and checkups, monitoring parameters like blood pressure, and ensuring the practice maintains its quality of care.

So this is all tremendously useful, but won’t necessarily be easily transferrable outside the particular practice. It could even be necessary to print out the EMR and send it via mail when transferring the information to another practice, which could then entail manual data entry at the recipient’s end, or at least scanning.

An EHR is more than that. Whilst it should contain the same information as an EMR, an EHR is meant to link to data from other healthcare providers such as laboratories and specialists, as well as every practitioner the patient has consulted throughout their medical history. The data can move much more easily with the patient, as they are referred from one practitioner to another.

So, for example, an emergency department will know immediately about a patient’s life-threatening allergy, or a patient can be given access to their own information so they can see how their medication is improving their health, potentially motivating them to keep taking it.

Lab results will be immediately available, as soon as they are completed, so the specialist won’t need to run the tests again for their own purposes. A patient’s transition from one care setting to another – such as hospital to home – can also be made more smoothly.

Of course, an EHR system is an incredibly complicated thing, as is any interlinking of multiple disparate databases. There are literally hundreds of different providers now offering EHR applications, creating a market valued at billions of dollars.

These systems are not necessarily compatible with each other – many of them aren’t and, even when they are, the information exchanged may be a small subset of what is available, such as billing details for private providers. However, there are standards being developed, such as openEHR, HL7’s Virtual Medical Record, and Substitutable Medical Apps, Reusable Technologies (SMART).

The NHS now uses a system called Summary Care Records (SCR). This is an EHR, but isn’t a complete file of the patient’s entire medical history. It contains only the most important information: medicines you are currently taking, allergies you suffer from, and any bad reactions that have been recorded to medicines that you have previously experienced.

Your name, address, date of birth and NHS number are used to ensure correct identification. You can also ask to add further details to your SCR, although only if both you and your GP agree to this. Some regions have begun to bring together health and social care records into a single Integrated Digital Record, with Camden in London being the first. But this is only very limited so far.

For now, the greater details of medical records remain in the silos of individual practices. Lorenzo patient record systems have been adopted by a few NHS trusts in the UK, but the grand plan to roll out a universal EHR system across the UK was famously problematic and has now been discontinued in favour of a Veterans Health Information Systems and Technology Architecture (VistA) system.

This system has been successfully deployed in Jordan, but hasn’t been implemented in the UK yet. However, the UK does have one of the most advanced systems for general practitioners. Whilst this isn’t one live EHR system, the GP2GP system allows EMRs from one practice to be transferred to another electronically, and almost all GP practices are computerised. The GP EMRs contain much more information than the SCR.

However, there will still be a persistent need to transfer some information in paper form, which is where a multi-function printing device such as HP’s OfficeJet Pro X576dw will be essential. The ability to print out records quickly, quietly and cheaply with permanent ink will be required to send patient records to practices, or for prescriptions, and it will be necessary to scan records into a practice’s EHR or EMR system when they are received, both of which the X576dw can perform with aplomb.

In 2010, HP also launched an initiative called EHReady, aimed at helping physicians adopt new technology. The initiative assists them in choosing the right mobile systems, desktops, printing solutions, servers, storage and peripherals for their favoured EHR solution. HP’s Z Workstations have been specifically designed with EMR/EHR usage in mind, as well as for picture archiving and communication systems (used with imaging systems such as X-ray and MRI), point-of-care healthcare applications, and the growing area of telehealth.

The EHReady initiative isn’t just about finding the best hardware, but also helping hospitals and general practitioners work together to obtain the huge benefits that a universal EHR system has to offer. This includes flexible equipment financing as well as system installation, training, and ongoing support. Making the doctor’s desk covered in paper records a thing of the past can pay huge dividends, with the main benefit being to the patient.

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