Advantages of computer-based medical records

Adapted from Panel 1 of:
Powsner SM, Wyatt JC, Wright P. Opportunities for and challenges of computerization. The Lancet 352:1617-1622; 1998

Simultaneous, remote access to patient data
Multiple clinicians can access a patient's record simultaneously from many locations. With the recent advent of secure data transmission over the web, clinicians can now review and edit patient records from anywhere in the world.
Legibility of record
Handwritten charts are notoriously difficult to read. On-screen or printed text is often far more legible than handwriting.
Safer data
New users often fret over the potential for lost data due to system malfunctions. With a well designed and tested backup scheme and disaster recovery system, a computer-based record is much more reliable and less prone to data loss than conventional paper-based records.
Patient data confidentiality
Record access can be restricted and monitored automatically; each user can have specific levels of access to various data types. Audit logs can be screened electronically to look for statistical abnormalities which may signal unauthorized record accesses.
Flexible data layout
Users can have a separate data display and data entry screen, recall data in any order (e.g., chronologically or in reverse chronological order), and create disease or condition specific data review formats. Paper records suffer from temporal constraints in the sense that data are fixed in the exact sequence in which they were recorded.
Integration with other information resources
Once in electronic form a patient's data can be linked to reference information stored and maintained locally or, via the internet, on a computer half-way around the world.
Incorporation of electronic data
Physiologic data can be captured automatically from bedside monitors, laboratory analyzers, and imaging devices located throughout the healthcare enterprise. Such data capture is free from the uncertainties and unreliabilities of human data entry efforts.
Continuous data processing
Provided that data are structured and coded in an unambiguous fashion, programs can continuously check and filter the data for errors, summarize and interpret data, and issue alerts and/or reminders to clinicians following the detection of potentially life-threatening events.
Assisted search
In a small fraction of the time required using a manual system, computers can search free-text (or as Octo Barnett terms it "expensive text") as well as structured data to find a specific data value or to determine whether a particular item has ever been recorded. However, unstructured text must be searched with care since clinicians use many different words and phrases to express the same clinical concept.
Greater range of data output modalities
Data can be presented to users via computer-generated voice, two-way pagers, or email, for example. In addition, instructions can be sent to external, computer-controlled devices like automatic pill dispensers, or infusion pumps which will then carry out the clinician's intended action. Patient-specific alarms can flash lights, ring bells, or buzz buzzers. Finally, multiple single plane images can be transformed back into a single 3-dimensional image and superimposed on the surgeon's field of view.
Tailored paper output
Data can be printed using a variety of fonts, colors, and sizes to help focus the clinician's attention on the most important data. In addition, images can be combined with textual data to create a more complete "picture" of the patient's condition.
Always up to date
If the electronic record is integrated, then all data is immediately available to all practitioners regardless of their physical location as soon as the data is entered into the computer. This eliminates the problems associated with several physicians, each keeping a small portion of a patient's medical record in their offices and transferring these paper-based records back and forth as they consult.

Ó 1999 Dean F. Sittig

dfs 1/5/99