Projecting the electronic medical record

Just because you can doesn't mean you should. We all are aware of things that technology can do that could be detrimental in the long run. Just because I can play electronic solitaire on my computer doesn't mean I should spend hours of my time doing it.

At a recent peer review committee meeting that I attended, the peer review coordinator arrived early to set up the projection of the electronic medical record (EMR); the peer review staff thought that having this advanced technology would aid committee discussion for case review. But with the introduction of any new idea, one always has to look at the pros and cons before assuming that change is better.

At issue here are three necessary principles for an effective peer review committee:

1. The preservation of provider anonymity
2. The efficiency of committee time
3. The level of trust amongst physician committee members

In the old days, about three or four years ago, when we only had a paper record, the peer review coordinator would bring the chart to the committee meeting and if questions arose that required additional clinical information (such as what was the hemoglobin level prior to surgery, did the operative report indicate the intraoperative findings accurately), either the coordinator or the reviewer would look at the chart to find the relevant data. In looking at the paper record, only the individuals who already were familiar with the case and the provider would look at the data. This preserved provider anonymity and therefore allowed for a fairer case discussion. When the electronic record is projected, however, everyone at committee analyzes the provider and anonymity is lost.

What about committee discussion efficiency? With paper records, while one individual was looking at the chart to get further information, the rest of the committee was free to continue its discussions on other concerns until the information was available. When the committee projects the medical record, I've observed that the entire committee becomes focused on that issue and until the information is found, further discussion ceases. Part of this problem is the difficulty of retrieving information from an EMR. As many of us have learned, sometimes finding a restaurant using a search engine can take more time than just opening a phonebook (if you still have one).

The third issue is a bit more subtle. With the paper record, occasionally we would pass it to an individual to apply his or her specialty expertise. In general, committee members trusted the individual reviewer to relate to them what the record contained. With EMRs, some committees now want everybody to take a look at things because they can (i.e., the record is available and easy to access). To some degree, it undermines the trust that we have in one another that the individual will relate accurate information to the group.

I hope you don't think that I'm trying to reincarnate Andy Rooney and play the old curmudgeon. I am very much a proponent of the use of EMRs and peer review. It allows physicians to review cases without having to come into the quality office during defined hours, it increases the ease of document retrieval, and it clearly can be used to find data that will help drive OPPE in the future. Best practice would be to have the EMR available on a laptop during a committee meeting so that either the peer review coordinator or the reviewer can look at the record to obtain additional information and then relate this information to his or her colleagues. It is up to your organization to determine if projecting it is progress or merely change.

Robert J. Marder, MD, CMSL, is vice president of The Greeley Company.