Electronic medical records (EMRs) are digitally-formatted archives of a patient's medical and treatment history. Although most American doctors had yet to implement the use of EMRs as of early 2009, these numbers were expected to increase, as the 2009 economic stimulus package allocated funds as incentives for health care providers who implemented EMR technology in their facilities. Usage should rise further as CMS (US agency) will allow EHR-based quality metrics to be submitted by physicians in 2010 with simplified medical billing coding to gain an incentive for usage. The expectation is that these medical records in electronic format will result in better care coordination.

Many practices use software for medical billing but EMR/EHR medical software has been adopted slowly in the past. Potential adopters of an EMR should keep in mind that computerization introduces new kinds of errors called e-iatrogenesis.http://sites.google.com/site/hcinfosys/literature/eiatrogenesis In addition, upwards of 80% of EMR adoptions fail especially large scale ones.http://sites.google.com/site/hcinfosys/literature/failure At the end of 2008, 207 vendors market their software as an EMR, while 59 use the term EHR. http://www.softwareadvice.com/articles/medical/ehr-vs-emr-whats-the-difference/

Most EMR initiatives have failed according to an academic study in a Milbank Quarterly January 2010 article by Greenhalgh, Potts, Wong, Bark and Swinglehurst at University College London titled "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method".http://eprints.ucl.ac.uk/18821/ They noted that homegrown systems tended to be better received. Some doctors are having buyers remorse on ill-advised systems or vendors going bankrupt.http://huffpostfund.org/stories/2010/01/shopping-health-software-some-doctors-get-buyer%E2%80%99s-remorse

There is often a mis-conception about what an EMR does. Is it just the patient chart? Here is a list of typical functions and features in an EMR.http://www.emrexperts.com/emr-ebook/emr-functions.php EMR vendors fulfill these features to varying degrees.

1. Patient Charting

2. Order Communication Systems

3. Clinical Decision-Making Support Systems

4. Document/Image Management

5. Patient Portal

6. Statistics and Reporting

Non-IT decision makers are likely to overlook security, privacy, integration, certification, and clinician education (i.e., user resistance).http://www.businessweek.com/idg/2010-03-02/deadline-for-e-health-rollout-may-do-more-harm-than-help.html Some vendors are providing financing terms that may prove to be problematic in the long-run.http://www.modernhealthcare.com/article/20100302/NEWS/303029988#

A Commonwealth Fund study shows that EMRs come with mixed results with respect to patient communication.http://www.dotmed.com/news/story/12258/ While EMRs provide up-to-date information on patient history (if data has been input), some clinicians overly rely on EMRs for information gathering and transfer. This distraction can result in less real-time communication with patients and other clinicians.

Other obstacles are nuts and bolts decisions that are overlooked. For example, where do you position the computer in the examination room to facilitate communication?http://www.hschange.org/CONTENT/1125/ Dr. Chen in this New York Times article says she jots notes down and types them in outside the examination room because of an unnatural computer-patient arrangement.http://www.nytimes.com/2010/04/22/health/22chen.html

The merger of Allscripts (medical practices EMR) and Eclipsys (hospital EMR) may be the first of a wave of consolidations in the EMR industry.http://blogs.forbes.com/sciencebiz/2010/06/allscripts-eclipsys-merger-electronic-health-records-land-grab/ While seemingly disparate systems, the merger might reflect the move towards hospitals strengthening their ties with physicians who admit patients.