An Oklahoma business magazine recently published a story about the wonders of electronic medical records (EMR).  Something I have always known but have not actually written about on this blog is the distinction between an EMR system in a physician’s office and an EMR system in a hospital. 

EMR can be a great patient care tool in the ophthalmologist’s office where digital pictures of the retina, for instance, could be stored easily for later comparison.  EMR is helpful for viewing or comparing X rays or other imaging studies in the physician’s office.  The confidentiality of these records is on the physician’s back, just as it is with his paper records of the past.  

EMR’s serve the big hospitals in another way.  Big hospitals use these systems to control the flow of patients and therefore to control their physician employees.  One touch of a key in the administration’s office and no more referrals go to Dr. X.  Dr. X might be excluded for any number of reasons.  Use your imagination. 

One are hospital has admitted to a $450,000,000 budget for their EMR system.  You know they are going to want that back.  And they will get it back.  From you and me.  First, the “federal government,” which of course has no money it didn’t first extract from taxpayers at gunpoint, paid this and other hospitals (and physicians for that matter) to adopt these systems.  Second, the EMR system will allow for complete control of expensive tests and referrals.  Patients won’t “leak” out of the system.  All revenue from a patient’s condition will be “captured.”  That’s how the guys in suits talk.  At the end of the day, health care costs a bundle and there seems no way out, as all of the physicians and facilities are bundled together, comprising some amorphous unattackable blob.  Tests will be ordered automatically.  Drugs will be administered without the need for physicians to order them.  All of this will be charged for.  If a physician objects to any of this, referrals will simply be directed away from him to someone else who is more of a “player.” 

Without EMR, hospitals lose this control over the patient’s “billable encounters.”  With EMR hospitals maintain their control over the physicians whose practices they have destroyed.  All done in the name of safety and quality.  

G. Keith Smith, M.D.