BESHAR AND HIEBERT: iPads in the emergency room?

A doctor’s treatment plan is supposed to guide you to health, but what happens when two doctors prescribe two different solutions, especially when these treatments are for our entire population?

The American health care system is a minefield of such debates. However, a particular generational divide has informed one discussion: electronic medical records. In January, a panel at Yale on the Affordable Care Act demonstrated this gap. One panelist, an older practitioner, denounced medicine’s embrace of electronic medical records. Another panelist, a younger medical student, heralded the paper-free system.

It’s easy to see where the disagreement lies. Electronic medical records may prevent misplacement of charts, illegible writing and the improper prescription of dangerous drug orders. The technology automatically reminds doctors to ask patients about allergies and graphs the progression of a patient’s health over time. Most importantly, electronic medical records may help integrate hospitals and doctors’ offices so that patient records can be more easily shared. This will shorten lag time between visits and offer life-saving expediency in emergency rooms.

Yet, electronic medical records are not perfect. While they may reduce costs in the long term, their short-term costs are mind-boggling — possibly over $20 billion to institutionalize them nationwide. Computers can become barriers between the patient and the physician, weakening the interpersonal interaction so key to establishing doctor-patient trust. Electronic medical records — with their one-click buttons and copy-paste features — may prompt doctors to streamline physical exams and medical history. One review of electronic medical records revealed that a patient was on “day 2 of antibiotics” for five consecutive days — a clear misuse of “Apple-C.” Because of these reasons, the CDC reports that just less than 50 percent of American hospitals employ electronic medical records.

We can see the debate over electronic medical records playing out today at Yale-New Haven Hospital (YNNH). EPIC, “a state of the art integrated information system that combines all available patient information in a single database to improve all caregivers’ ability to review information and treat patients” was introduced to YNNH in 2011 according to their website. The system allows YNNH to integrate with its partner hospitals in Greenwich and Bridgeport. However, its implementation has not been easy — living up to its name — and has involved the training of 5,675 medical staff and ultimately affected 1,500,000 patients.

Nurses, in particular, have strong opinions about the new online system. EPIC’s new functions and protocols for recording information require substantial adjustments to work habits. As a result, completion of an ordinary patient assessment often exceeds the available 10-minute interval. The nurses also exemplify the generational divide on technology. While older nurses find it difficult to enter measurements or observations — as EPIC’s sidebar of tabs are not straightforward — younger nurses overall seem more patient and optimistic that the transition will become easier with time.

The generational problem may provide its own solution. Our generation is uniquely comfortable around technology. We grew up fiddling on iPads, ordering Starbucks coffee with our iPhones, and making reservations and appointments on the computer. Unlike our parents — who type with their two index fingers — we can type in the dark, blindfolded or with our eyes closed. In doing so, we’ve created a culture in which technology is normal, comfortable and ubiquitous.

But technology should not support laziness. There is no high road to health. Just as DDT failed to kill all mosquitoes or penicillin failed to cure all infections, electronic medical records cannot exist as health care’s “magic bullet.” If electronic medical records are implemented nationally — and with the potential benefits, they should be — then stricter regulations are needed. Privacy and confidentiality need to be ensured, technological shortcuts prevented, and the doctor-patient relationship preserved and cherished.

Isabel Beshar is a junior in Saybrook College. Lindsey Hiebert is a sophomore in Pierson College. Contact them at isabel.beshar@yale.edu and lindsey.hiebert@yale.edu .

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