Research paper

Dani Abi-Najm

Anyone who has ever been to the doctors office or a hospital has seen a doctor or
nurse use a medical record. In todays world, the medical record is a legal document
providing a chronicle of a patient's medical history and care, (Purdue University). Dr.
Richard F. Gillum, a doctor at Howard University in Washington, D.C. states that
medical records were first developed with the intent of using them for instruction on how
to treat patients and an early example of didactic recording is an Egyptian case report,
known as the Edwin Smith Papyrus, was a text on surgery dating to 1600 bc (Gillum, 1).
The medical record has gone through several transitional phases; the medical record
began as a tool for teaching, then changed into a tool for keeping track of admissions and
discharges from hospitals, and then developed into an aid to physicians for treating the
patients. During its most recent transition, the medical record has been undergoing a
significant change via digital technology; starting in the 1960s, there has been a
development of the electronic medical record, or EMR. My purpose for this essay is to
provide a concise history of the medical record in order to develop a platform on which I
will discuss the positive and negative effects of the role that technology has played in
developing the new (electronic) version of the medical record.

A brief history of the medical recorded is going to be needed in order to

understand how they work and how they have developed into what they are now. The

medical record first appeared in the period of Ancient Egypt and continued to be used in
Ancient Greek and Ancient Roman societies as
well. Dr. Robert H. Wilkins, a neurosurgeon at
Duke University Medical Center, wrote an
article about the Edwin Smith Papyrus, a well-

Edwin Smith papers, a scroll approximately 15 feet long with 48

accounts for various diseases (circa 1600 BC).

known medical record that has been recovered

from the Ancient Egyptian civilization which
consists of 48 cases that are typical, not individual, (Wilkins, 1). Medical records from
Ancient Egypt were written on papyrus since that was the only paper-like material
available. The medical records that were used in these time periods were used for
instructive purposes; typical injuries were described and the medical student would have
to think of a diagnosis and treatment plan based on the symptoms or injuries described.
During the early 1800s, cases were recorded in casebooks and a physicians assistant
recorded these cases retrospectively by date of discharge, using a freeform narrative
style based on personal notes they had maintained, which shows that there was no
structure to these medical records. This marks a transition from them being used for
didactic purposes to them being used in hospitals (Siegler, 1). One American doctor,
Benjamin Rush, used medical records to keep track of his practices of bloodletting and
purging (Gillum, 1). This is an example of how the medical records were not used as a
tool for actually treating the patient, but as a tool for recording what was done to them.
Dr. Eugenia L. Singer, the author of The Evolving Medical Record writes that during
the mid-1800s, the medical record was put to work in hospitals; in this period of time,
they were loosely structured narratives of all admissions, (Siegler, 1). To make it

simple, these medical records were more used in a doctor-to-doctor setting rather than a
doctor-to-patient setting; Dr. Richard F. Gillum states that it was not until 1898 that the
patient record originated at the bedside rather than an abstract or copy became the official
hospital record, (Gillum, 1). Until the 20th century, medical records were used for
administrative purposes; the clinical records that were used in direct patient care in
hospital and ambulatory setting were not developed in the U.S. until the 20th century.
During the early 20th century, there were reforms at many hospitals and institutions to
accommodate the acceleration of specialized medicine and one major innovation was to
assign each patient a clinic number and all data for the patient, their history, symptoms,
allergies and concerns, were all organized in a single place and doctors were now able to
treat the patient more effectively. In the mid-1900s in the U.S., the hospitals implemented
a standard format for all medical records in order to ensure organization and effectiveness
because different doctors tended to write about different things, which lead to confusion;
there needed to be a standard format to make sure the amount of mistakes that could be
made could be limited. The hospitals in Europe did the same, but their format for the
medical records were government issued. The most important transition of the medical
records began in the 1960s; an electronic medical record was now available and the goal
to changeover from paper to electronic medical records had been set.

IBM and Akron Childrens Hospital were pioneers in this expedition and they had
set an electronic system into the hospital in 1962 (Dr. Lawrence L. Weed is also credited
for further developing the Electronic Medical Record (EMR) while he was working at the
University of Vermont in 1969) and this marked the beginning of the transition to

electronic records. There needed to be a transformation in patient care and he believed

that the implementation of an electronic record would be the most innovative (Gillum, 1).
The nurses and physicians of the time had to handwrite their medical records and then translate them
to electronic form via I.B.M. Ramac 305 (a
A nurse writing in a paper medical record
with an IBM Ramac 305 to her left. (1962)

machine developed by IBM to hold the EMRs);

this does not seem that time-conservative (and it
wasnt) but there needed to be babu steps taken in

order to help the doctors adopt the EMR, they couldnt just leave the paper records cold
turkey. Steve Lohr, a writer for the New York Times, said that Roger Sherman, who was
hospital administrator of Akron Childrens Hospital, favored implementing the EMR
because he believed that doctors and nurses will be able to spend more of their time
using their professional training to give more direct and attentive care to patients,
instead of wasting countless hours filling out paper work for them. Another perk for
having an electronic health record is to easily keep track of drug dosages as to not make
any silly mistakes when administering the drugs. The effect that technology had on the
development of the EMR was a positive one; although the EMR is still being developed
and implemented, the health care system would not have progressed without it. The speed
that tasks can be done in a hospital or a doctors office is at an all-time high, thanks to
this new technology. I found an example of this transition still being underway: while I
was watching Greys Anatomy, I realized that the doctors in the hospital used both paper
and electronic records. The doctors used the paper records to record and keep track of the
symptoms but use the electronic records for billing and ordering prescriptions and lab

tests. Lab results, financial bills and prescription orders would not be as easily shared
without them; some physicians are still skeptical about using the EMR and pros and cons
of using the EMR will be outlined in order to provide an overall view of the effects of it.

The EMR has multiple benefits to it. One of the key reasons the EMR was developed was
to implement organization; the EMR provides a single place where each patients history,
list of medications, symptoms, treatments and
bills are kept in order. Dr. Jacqueline EghariSabet, a double-board certified allergist who
An example of a patients chart in an EMR

owns her own practice in Maryland, says that

her life would be a lot harder if she hadnt installed the EMRs into her office a few years
ago; she uses tablets to save space and paper when she uses the EMRs in her office. It
makes it hard to lose data when it is in a computer, unlike paper records where pieces of
paper could easily fall out of folders and critical information be lost. Doctors are
notorious for having terrible handwriting and illegibility of notes could possibly lead to
fatal mistakes; misinterpretations of doctors notes could lead to wrong dosages or
combinations of drugs that could be detrimental to a patients health. If all of the data is
input into a computer, there will be no misinterpretation because it would all be typed and
clearly formatted. Patients records could also be easily shared between offices and
clinics and hospitals; the records can be shared via email or database and it saves time
and mistakes of transporting written records. According to William R. Hersh, doctors
who use the system were found to generate 12.7% less charges without compromise in
patient care and their patients also spent nearly one day less in the hospital, (Hersh,

774). This shows that the use of an EMR in a clinical setting or hospital saves the patient
their precious money and time. The EMR also includes an online order system, which is
used to order drugs needed for the patients; because they are ordered electronically, they
are able to be more easily controlled and will not be over ordered, thus saving the
hospital and patients money. Algorithms can be put in place to calculate the best
treatment plan for the patient; doctors can compare the different treatment plans the
computer has created and determine which one would best fit the patients lifestyle. The
EMR is thought to be environmentally friendly because it saves piles upon piles of papers
and also eliminates the space that would be needed to store all of the paper charts.
Although all of these reasons make the EMR seem like an excellent idea, there are
a few drawbacks. One of the major problems that occur when using any electronic device
is freezing or crashing; we all know the frustration that accompanies the failure of a
computer or tablet and this could be detrimental to a private practice, a hospital, or even a
patients life because critical information could be lost. Another key issue that some
physicians find in the EMRs is the risk of not having complete patient confidentiality.
One might think that a computer would be more secure than a paper folder but Hersh
explains that since the pace of medical care in emergency settings, as well as busy
clinical areas, can be hectic, providers may become frustrated with layers of security, so
the security on the EMRs may be easily breached. EMRs are also very expensive to
install and hospitals or private practices may be reluctant to implement the EMR because
they are already tight on budget. Some physicians are worried that the use of an EMR
will devalue the patient-physician relationship but it is to remember that the electronic
health record/electronic medical record must enable this relationship, not interfere with it

as when the physician faces a computer screen with back towards the patient, (Gillum,
1).
After reading so many sources about the positive and negative effects of the
EMR, I cant help but believe that it would be easier and more effective to have the
records in an electronic form rather than a paper form. Time does get saved because on
an electronic device, a click of a single button can do the same job as writing a paragraph
can. Everything is concise and easily accessible; there would be no more sorting through
hundreds or thousands of papers just to find the right one, it could all be uploaded onto a
software and a physician could search for it on there using a few key words. Having an
EMR established in a hospital or office is also environmentally friendly because it saves a
substantial amount of paper. This movement in the 21st century to move from paper to
electronic records is inevitable with the world becoming more and more digitalized
everyday, and the realm of health care has to keep up with it. Maybe in the future there
will be an EMR developed that is something completely beyond our imagination at this
time.

SOURCES:
1.
The Miracle of Digital Health Records, 50 Years Ago- steve lohr

Lohr, Steve. "The Miracle of Digital Health Records, 50 Years Ago." The
New York Times 17 Feb. 2012. Web. 17 Oct. 2014.
<http://bits.blogs.nytimes.com/2012/02/17/the-miracle-of-digital-healthrecords-50-years-ago/?_php=true&_type=blogs&_r=0>.
2.

FROM PAPYRUS TO ELECTRONIC TABLET- gillum

Gillum, Richard F. "From Papyrus to the Electronic Tablet: A Brief History

of the Clinical Medical Record with Lessons for the Digital Age." American
Journal of Medicine (2013). Print.
3.

The evolving medical record siegler

Siegler, Eugenia L. "The Evolving Medical Record." Annals of Internal

Medicine (2010). Print.
4.

The Electronic Medical Record: Promises and Problems hersh

Hersh, William. "The Electric Medical Record: Promises and Problems."

Journal of the American Society for Information Science (1995). Print.
5.

http://www.neurosurgery.org/cybermuseum/pre20th/epapyrus.html

Wilkins, Dr. Robert H. "Cyber Museum of Neurosurgery." Cyber Museum

of Neurosurgery. 1 Mar. 1964. Web. 20 Oct. 2014.
6.

picture of edwin smith papers:

http://nihrecord.nih.gov/newsletters/2008/01_25_2008/images/story7Pic1.jpg

7. interview: Dr. Jacqueline Eghari-Sabet, a double-board certified allergist who owns her
own practice in Maryland and who also attributes to the health segments on NBC4.