Ready or not, electronic medical records (EMRs) are coming. President Barack Obama has devoted $20 billion to healthcare IT in the American Recovery and Reinvestment Act, and in February 2009, he announced his aspirations to have an electronic health record for each person in the U.S. by 2014. Dr. James Pierce, chair of the Bioinformatics and Computer Science Department at University of the Sciences in Philadelphia, notes that a nation-wide implementation of EMRs comes with considerable challenges, as well as tremendous advantages.

“Digitization of the healthcare system will be much more efficient and cost-effective, and will enable easier communication among different parts of the system, simpler manageability, and less storage compared to paper records,” explained Dr. Pierce. “EMRs allow healthcare providers to send queries electronically, which is expected to decrease the errors that are made on paper and ultimately, save lives.”

Despite the clear benefits of EMRs, there are important issues that need to be addressed before implementing the system, Dr. Pierce cautioned.

• Storage: While EMRs will likely be stored in internal hospital systems or external servers, each patient’s file could generate a colossal amount of data. “In the near future, terabytes of information may be generated during a doctor visit,” said Dr. Pierce. “It’s very difficult to transfer files of that magnitude, and the software must be able to store and send every x-ray, cat scan, genomic analysis data, MRI, prescription, and test that a patient gets.”

• Compatibility: Because most EMR programs are developed and sold by private companies, different hospital systems may not be interoperable with each other, making the transfer of electronic files complicated or impossible. Rapidly changing technology also poses a financial strain. “When a hospital or physician’s office invests millions of dollars into purchasing a system today, it may be outdated in five years, at which point, it can be very expensive to update and get a new program.”

• Privacy and Security: Given the infinite shelf-life of electronic files, EMRs incite debate about serious privacy, security, and ownership concerns, as well as the potential for past medical information to be used against a person. Dr. Pierce hypothetically notes a person who was prescribed antidepressants in college, and years later, the individual may not want this information available to potential employers. However, if the patient’s history is catalogued in an EMR, it will not only live-on forever, it is also highly accessible.

• Training: EMRs are still a relatively new system, and as such, require a form of interdisciplinary training that is not yet widely available. “Traditionally, hospitals staff an IT person who has little or no training in healthcare, and doctors and nurses who aren’t familiar with IT,” said Dr. Pierce. “A nation-wide move to EMRs prompts the need for trained individuals who are well-versed in both IT and medical technology.”

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