The Hospitalist & the Electronic Medical Record

the Center for Medicare and Medi-caid Services (CMS) released full details of the proposed Electronic Health Record Incentive Program [1]. These proposed rules set initial requirements which hospitals and health care providers must meet in order to qualify for economic incentives under the American Recovery and Reinvestment Act (ARRA). Since the sixty day comment period ended on March 15, 2010, we can anticipate a final version of the rules to be published very soon. The linkage of hospital reimbursement to the development and utilization of the electronic medical record (EMR) has further escalated the pace at which hospitals are converting their orders and documentation from paper-based to electronic processes. Most hospitals already using EMRs are busy identifying the areas outlined by the CMS rules which will require further adoption in order to reach specified thresholds. As hospital-based physicians, hospitalists find themselves integrally involved in these changes. Is the acceleration of the rate of EMR adoption good for hospitalists? There is no simple answer to this question, since many hospitalists who have used EMRs admit to ambivalent feelings about these systems. They know that features such as computerized provider order entry (CPOE) have been shown to decrease errors due to poor legibility, reduce adverse drug events and decrease the time for medication delivery; however, the electronic processes also induce opportunities for new types of errors [2]. Many physicians using CPOE have noted a slight increase in time spent writing orders ; however, this is usually offset by time savings that occur due to less phone calls and order clarifications [3]. Many hospitalists find that changing inpatient documentation from paper to electronic is the most challenging feature of EMR adoption. The Press-Ganey Corporation recently reported that physician satisfaction with EMRs is decreasing throughout the nation [4]. Although some of this dissatisfaction may be expected during the " learning curve, " other factors may include feelings that they have not had an adequate voice in the EMR selection process or the belief that some EMR products (cont)