The doctor is in and logged on

Electronic medical records eliminate many of those fundamental problems -- notes, orders and prescriptions are clear and contiguous. There's no waiting for paperwork. And if a patient of mine shows up in another office across town (remember, Kaiser is an integrated system -- we all share the same computer network), a doctor whom I have never met can see what I've written, my patient's list of problems and what I've done for the patient in the past before he or she even sets foot in the room to talk to the patient.

Such record systems can alert us to possible medication errors or dangerous drug interactions. They can continuously be updated to identify best practices. And they talk to patients as well, allowing them to access past-visit information and immunization records and to make appointments and send e-mails to their doctor.

Finally, they help better integrate care. When a woman came to a routine eye appointment in our medical group, the nurse noticed a "preventive health prompt" in the patient's medical record saying that she was overdue for a mammogram. The nurse booked her for a mammogram and, when the woman had it done a short time later, her doctors discovered early breast cancer. She was treated and remains well today.

Valid criticisms

All of this being said, electronic medical records have their critics.

In March, as President Obama was announcing his plans for healthcare reform, Harvard doctors Jerome Groopman and Pamela Hartzband wrote an op-ed in the Wall Street Journal questioning some of the records' purported benefits. They wrote: "A study of orthopedic surgeons, comparing hand-held PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort. But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error."

That's a valid criticism, but these are data entry and vigilance errors by health professionals taking care of patients, the kind that can be remedied by holding doctors and others accountable for the accuracy of their documentation.