As a chief resident in Orthopaedics, about to enter practice after a one year fellowship, I have put a lot of thought into EMR and how to use it in my future practice. Especially because the practice that I plan to join is completely run by paper....no electronic anything! I have spent a lot of time looking at various PACS systems and EMR's, specifically for the Macintosh platform. I couldn't agree more with Dr. Luks' comments on the current state of EMR.

"The currently available EMR packages are not very user friendly, can not cross-collaborate, do not publish computable, actionable date that is inter operable across various platforms, do not improve patient flow, have not been shown to improve care..."

People in my generation who are currently entering the medical field as practicing physicians have "grown up" with computers. However, many of the currently practicing physicians do not enjoy this advantage. This situation sets up what I refer to as the "digital divide." There is a divide between younger physicians that are comfortable with computers, and established physicians that are not. I am not saying that many of the established physicians have not been able to adapt. Dr. Luks is a good example of a physician who has bridged this divide. However, there are a significant number of physicians out there who have not. The current EMR's are not even close to being "user friendly" enough for these physicians. If the Obama administration mandates that every office and hospital adopt EMR, then how do we deal with the established MD's on the other side of the divide? If we wait long enough, this problem will become less of an issue as physicians reach retirement age. This does not help in the near term though.

Interoperablity is also a major issue. Getting information from one doctor or hospital to the next is nearly impossible now. This results in duplicate tests and wastefulness. Instead of mandating that every physician and hospital adopt current EMRs, the Obama administration should instead mandate a set of software and hardware guidelines and formats that EMR vendors are required to follow. Then EMR companies can market themselves as "compatible" with the Obama EMR plan. This will also allow the practicing physician to buy the EMR that is best suited to his or her practice and not have to worry about if the information stored on such a system will be useless when an upgrade is needed.

Basically, for Obama to just say that EMR's are now required, without first fixing the issues plague them, will only create more problems with health care cost, flow of information, and ultimately patient care.

One last point is that the government may have a solution that is already in place and functioning. The Veteran's Affairs Administration has had an EMR that is universally adopted and available across the country and event the world. It's offices and hospitals are linked through this EMR and information is easily passed from hospital to physician and from physician to physician. I do not have a lot of personal experience with this EMR, but have seen in in action as a medical student and know several physicians who use it. They consider it to be an indispensable asset when caring for our veterans. So maybe the Obama administration doesn't have to re-invent the wheel. Maybe if they look internally to the VA, the problem of a universally accepted and functioning EMR has already been implemented and now just needs to be expanded upon. Maybe they don't need to pump $30 billion into creating a new system that will likely be plagued with the problems outlined above.

Travis J. Kemp, MD