Letters to the editor.

I read with interest the special issue of The Physician Executive on health care technology. (Vol. 30, #2 March/April 2004)

As chief of the medical care service line (oversight of inpatient, consultative and ambulatory specialty care) at the Salem Veterans Affairs Medical Center (in Virginia). I have had the privilege of seeing our electronic medical record evolve. Although there have been several bumps in the road, CPRS (Computerized Patient Record System) has truly advanced our ability to provide care.

CPRS is a remarkable tool that, once the databases are populated, can save time and enhance productivity. It allows more efficient and complete patient encounters, enhances patient safety on multiple fronts (from CPOE to bar code medication administration). Clinical reminders attend to primary and secondary prevention; view alerts notify the clinician of important patient care events.

CPRS facilitates pathway development according to best practices, standardizes patient care and eases admission processes. Real-time educational matter is available and the organization has developed tools to help clinicians with complex patient issues that have been identified as disorders that can be approached in the context of quality improvement.

Consultations are more productive with the use of computerized referral guidelines and suggested pre-referral workups. Information access and sharing between caregivers has been upgraded. Benchmarking and practice management are much easier. The imaging capabilities and ability to scan external documents in CPRS round out the system.

In the beginning (about five years ago), there were multiple naysayers. At present, I do not believe anyone would go back to the paper medical record.

On the downside, the organizational focus to go electronic has been intense. Some physicians (<10 percent) have left or anticipated their retirement plans. I know over the years my typing skills have improved but keyboarding has not been an issue for physicians at the medical center for years.

There, unfortunately, has been perhaps a 10 percent reduction in productivity in ambulatory practices; however, this may be compensated for by ready availability of data and clinicians' ability to provide more comprehensive encounters with more complete preventive care, in the context of current data and document availability. I imagine the costs of implementation and maintenance to be considerable.

Currently, we have fully adopted the electronic medical record in over 98 percent of our activities. It was done by the organization setting high expectations and not wavering on those expectations.

However, as alluded to by several authors in your health care technology issue, it was not until the physicians saw past the initial learning curve did the realization of the electronic medical record goal become achievable.

Sincerely,

Edward Arsura MD, FACP, MS Ed, CPE