Electronic medical records prove their worth


Computers trumped paper records in a recently published evaluation of a customised electronic medical record system (EMR) that was introduced at the Melbourne Sexual Health Centre. The Centre hosts the Sexual Health Unit, which is part of the Melbourne School of Population and Global Health at the University of Melbourne.
The introduction of EMR at the Centre in 2011 increased efficiency by 5%, enabling at least 2000 more consultations per year compared to paper medical records (PMR), according to the evaluation.
Professor Christopher Fairley, the Centre's director, said this was a conservative estimate because some practices at the clinic had already been electronic. In big picture terms, EMR was supporting the drive for greater efficiency across the health care sector, he said.EMR's efficiency improved the control of sexually transmitted infections (STIs) because it increased the community's access to healthcare, he said. "The prevalence of STIs within a community is very strongly predicted by access to health services." As an illustration, he cited gonorrhoea rates in heterosexuals, which are about 5 per 100,000 in Melbourne, and about 100 per 100,000 in the United States, which has no universal healthcare system.
Although more than 90% of general practices in Australia have adopted some form of EMR and 60% are paperless, EMR's impact had not been as thoroughly evaluated as in this study, Evaluation of Electronic Medical Record (EMR) at Large Urban Primary Care Sexual Health Centre, published in the open access journal PLOS ONE.
Synthesising the results of EMR evaluations was difficult because most EMR software programs were purchased 'off the shelf'. To gain maximum advantage from EMR, Professor Fairley said, if a clinic was large enough, its EMR needed to be custom designed and fully integrated into the entire service.
The Melbourne Sexual Health Centre's evaluation considered the efficiency of the service, the quality of the care, the views of staff, and the satisfaction of patients during nine-month periods before and after the introduction of EMR.
A key efficiency gain was that EMR allowed the centre to redeploy manual jobs that had previously tied up staff, such as registering patients at reception. Using EMR, patients registered themselves using computer touch-screens. A survey of patients confirmed that they had adapted to the changeover and, importantly, EMR had not harmed their relationship with their doctors. The quality of patient records was maintained and "practitioners overwhelmingly liked it – 89% were satisfied or very satisfied," he said. "The custom-designed EMR's advantages extended beyond those covered in the evaluation. For a large clinic, the decision to go electronic is a no brainer."
Among these other advantages was the capacity for practitioners to easily and privately obtain feedback via quality indicators. "People can print off a report of the completeness of their medical record against pre-agreed criteria and the process for audited quality control is substantially improved,” Professor Fairley said.
"Our EMR system also allows automated provision of behavioural surveillance to government. This gives them a much better idea of what's happening with sexually transmitted infection rates and behaviours."