Good longitudinal medical care requires a good medical record but most emergency situations don't. In an emergency, a computer won't save the person,
"Electronic Medical Records: Costly, But May Save Lives."
This headline from MedPage Today is typical of many in the popular press. The substance of these articles may then go on to describe a mixed bag of risks and benefits that a computer system (an EHR) might present, often including increased cost and decreased productivity.
The headlines, however, play to and reinforce the public expectation that these systems can routinely save lives, especially in emergency situations. An example may be cited of a patient that had an unusual medical condition that would have been overlooked in the ER and resulted in inappropriate or delayed treatment. Awareness of allergy histories is often cited as a potentially lifesaving benefit of an electronic record.
One wonders though, was the patient wearing a Medical Alert ID bracelet? A bracelet certainly would not encounter an Internet outage or an officious clerk at a remote facility who decides that providing the requested information might be a HIPAA violation or, if the patient is unconscious, trouble locating a family member that is allowed to give the necessary permission.
A different picture develops if you consider the real, life-threatening emergencies that present in emergency rooms every day; heart attack, stroke, trauma, acute abdominal conditions, and respiratory compromise lead the list. Proper management of these conditions requires several things: a first-responder mentality, awareness of and adherence to appropriate guidelines, and an ability act quickly and stay focused.
First-responders are trained in the ABCs of first-aid: airway, breathing, and circulation. Survival is proven to be maximized if transport time to the site of definitive treatment is minimized. Beyond first-aid comes ACLS (Advanced Cardiac Life Support) to deal with ventilatory support, blood pressure, and, perhaps, cardiac rhythm abnormalities while en route. Stabilization of the cervical spine may be required. The ability to recognize and initiate treatment for anaphylactic shock and certain poisonings (such as sarin gas) in the field can be life-saving.
In conditions such as acute MI or stroke, the rapid application of treatment as recommended by applicable guidelines can preserve life and function. The most critical success factor is to have a facility that is organized so that the proper treatment can be initiated as soon as possible - that means less than 1 hour and preferably less than 30 minutes.
The recent emphasis on a medical home for each patient highlights the difference between emergencies and "normal" healthcare. There is a large variety of non-emergency health problems that may afflict a patient during their lifetime. Many of these conditions initially prove to be difficult to diagnose; many illnesses have similar presenting signs and symptoms and it may take some time to elicit the necessary historical information from a patient for whom the illness is a new experience. In this setting, continuity of care is essential and a thorough and complete record of their history, examinations, tests, and treatments is an essential component. Complete, accessible medical records may be the only thing preventing every visit to the doctor from being like a new day in the movie "Groundhog Day."
Conclusion: Good longitudinal medical care requires a good medical record but most emergency situations don't. In an emergency, a computer won't save the person, the EMTs, PAs, doctors, and nurses are the ones who will do that. A computer might actually get in the way and divert attention away from the patient.
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