Letters to the Editor

I think your September 2007 article "EMR Pushback" was excellent. I can almost hear the wailing and gnashing of teeth by hundreds of electronic medical record software developers, but your article revealed a side to the EMR that I think needed to be brought out.

I think that the last paragraph of the sidebar, "The 'Moral Hazard' of Electronic Documentation," could have been stronger if it were a little clearer. As the paragraph reads, it sounds as if I found the phrase "first time seen patient" three times in the same report. A reader might receive that impression and rightly say, "So what?" The article would have been stronger if it had explained the fact that these three identical phrases were in three separate consultation reports for three successive episodes of care rendered on three different days. Obviously, a person cannot be seen three times, and each time is the first.

Additionally, the primary focus in quality improvement right now is evidence-based medicine. One argument for the EMR states that it will improve the physician's ability to practice evidence-based medicine, but not much current evidence is available to determine whether EMRs really improve quality of care in small physician offices. If they do improve quality, is that universal for all EMRs, just specific products, or only in certain types of practices?

Right now the enthusiasm for EMRs is fueled significantly by self-interested parties. Most of the "evidence" in favor of EMRs is experiential and anecdotal. Perhaps this is why one can picture some EMR vendors as they might have been 100 years ago, standing on the back of a wagon and selling patent medicines at a buck a bottle.

In 400 B.C., Hippocrates had this to say about the value of experiential data: "Life is short and the art long; the occasion fleeting; experience fallacious, and judgment difficult." Sorry if it steps on the small software developers' toes, but if an EMR's creator had to run statistically valid trials showing its EMR to be safe and effective before it is sold, I think we would have fewer and better EMRs on the market today. This requirement certainly would give the advantage to large, well-capitalized companies. -Bruce W. Landes, MD
President and CEO
Southwest Physician Associates
Dallas