A proposal for electronic medical records in U.S. primary care

Abstract

Delivery of excellent primary care-central to overall medical care-demands that providers have the necessary information when they give care. This paper, developed by the National Alliance for Primary Care Informatics, a collaborative group sponsored by a number of primary care societies, argues that providers' and patients' information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs). Although robust EMRs are now available, only about 5% of U.S. primary care providers use them. Recently, with only modest investments, Australia, New Zealand, and England have achieved major breakthroughs in implementing EMRs in primary care. Substantial benefits realizable through routine use of electronic medical records include improved quality, safety, and efficiency, along with increased ability to conduct education and research. Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S.

Figure 1.

The flow of information in primary care practice. (Adapted with permission from MH Ebell and P Frame.)

Figure 2.

“Face Sheet” for a typical patient. When a primary care provider sees a patient, the EMR typically provides a snapshot of key information, including but not limited to the patient’s demographics, problem list, medications, and health maintenance information. These and other data can be used to generate a set of reminders, which improve the likelihood that a patient will actually receive needed care. Without such decision support, it is extremely hard to rapidly determine what actions are due.