EMR: New Idea Collides With Old Human Nature


Harry S. Truman once said that the “only thing new in the world is the history you don’t know,” to which someone might flippantly rejoin that our plainspoken midcentury president had never had to program a VCR. However, Truman, if you recall, did wrestle with new technology — with the monster hatched by the Manhattan Project.

What would “Give-‘Em-Hell Harry” make of electronic medical records, the focus of Contributing Editor John Carroll’s cover story that begins on Page 24? The idea of putting patients’ electronic medical records — their charts — on the Internet is reasonably new. The motivations that create the desire for this, however, could have been written about in Sanskrit: the need to communicate better, the desire to heal with more precision. What’s not new about the technology are the questions it raises. How do we use EMRs? Do we use them at all?

Physicians, much to the chagrin of HMOs, seem to voice a resounding “nay” to the second question. So another new technology — the Internet — is now wheeled to the front to make the EMR technology more applicable.

Will this usher in the age of the EMR? We’ll go out on a limb and say no, because it’s less a matter of technology than of human nature. Physicians will not take the time nor make the investment necessary to throw their charts online. Are HMO executives listening? If they are, can they do something?

In this, health plans face the same hurdles in dealing with physicians that doctors face in dealing with noncompliant patients: How can you make someone do something without interfering with free will? Where does encouragement end and coercion begin?

“Man is condemned to be free; because once thrown into the world, he is responsible for everything he does,” said the French philosopher Jean Paul Sartre. This country, it should be noted, has always considered freedom a blessing. Can physicians really be blamed for not being technologically up to date?