House Calls / Dr. Michael Schwartz

Patients visiting their physicians may have recently noticed a new technology. Doctors are now using computers rather than charts and often spend much of the appointment typing as they interview and examine their patients. This might be confusing or concerning for some who are wondering exactly what is going on.

This recently created information system is referred to as an electronic health record or "EHR." In 2009, President Obama (as part of his health-care initiative) mandated that most medical offices incorporate EHR into their practice by 2015. Failure to comply would result in significant fines and penalties for physicians. Nevertheless, there is still much confusion surrounding the technology and privacy for both patients and physicians.

We interviewed Eileen Smith, executive director of Soundview Medical Associates in Norwalk. An expert in EHR, Ms. Smith explains how this new technology affects patients and patient privacy:

Q: What exactly is an EHR system?

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A: It is the clinical history of a patient's health, recorded by the physician and/or nurse in an electronic format. It documents medical history, vital signs, immunizations, laboratory tests, social history and care plan. It replaces the paper handwritten charts that often lacked organization and detail. In the past, doctors using paper charts often recorded this information in different ways, making it very difficult for other clinicians and patients to read and understand. The EHR system assures that all doctors record medical data in the same way. No more trying to decipher poor handwriting or trying to understand what dose of medication the doctor ordered.

Q: What are the benefits of the EHR system for the patient?

A: Assurance that every detail that the doctor feels is important for each visit is recorded with clarity and purpose and creates a medical record that can't be changed by anyone. Once entered into the system, the software guidelines help the physician document vital information for each and every visit. In addition, the physician/staff can order medications electronically, cutting down on medication errors by identifying alerts based on other medications and allergies.

Q: Do patients have to be concerned about their privacy?

A: Yes, of course, but the physician and staff are very careful to follow privacy guidelines. Both physician and staff take a course explaining security and privacy policies as set by our federal government. The training is repeated yearly and is mandatory for employment. As administrator, I limit the access to patient records to only what is necessary for that employee to do their job.

Q: Who can have access to EHR records?

A: Only physicians and staff have access and only for patient care use. Each physician and staff member is given a unique ID and password to sign into the medical records, making their access traceable and accountable. Our patients also have access to their own medical records by taking advantage of a "patient portal." This service is fairly new in the health-care arena, but certainly growing and it eventually will be a way to communicate to the doctor outside the regular workday. Unfortunately, not all doctor offices offer this service.

Q: What is the downside to using EHR for the patient?

A: The development and use of EHR is much more time-consuming for the physician, especially in the start-up process. The extensive documentation required for each visit actually slows down the physician, and sometimes can cause an interruption in regard to patient/physician interaction.

Q: How will EHR improve health outcomes?

A: Soundview Medical has developed disease guidelines. For example, when a diabetic patient's chart is opened for any reason, this chart has a section called "care management." That section lets the physician know what is needed for the care of diabetes, and that includes a link to the American Diabetes Association. This is a powerful tool that absolutely improves patient care and medical outcomes.

Q: What will the future bring for patients and doctors using EHR?

A: So much more! Software enhancements will provide the physician with disease state management. Guidelines based on age, gender and diagnosis will be readily available to the physician when the patient's chart is opened. How often diagnostic testing is needed, labs, medications and next appointment will automatically pop-up and improve patient care. Most importantly, the ability for the exchange of individual medical information to other health-care professionals and entities will be available.

Implementing the use of an EHR system is very costly and time-consuming. Furthermore, there are many different companies selling EHR systems and therefore practices may use different technologies. Therefore, sharing of information is currently difficult. Despite these limitations, it is hoped that EHR will offer improved health care while still protecting patient privacy.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, please visit his web site at