With EMRs there are very few limitations when it comes down to the technology that it uses.

The limitations and issues arise when it comes to the implementation and actual use of the EMRs. Problems exist with the local nature of systems that EMRs currently use as well as a lack of standards that EMR systems have adopted around the country. A very concerning limitation is access to the EMR when you are away from your home or from your physician. The main problem is that most systems are locality based. The problem with this is if you venture away from your home to go on a business trip or vacation and you get sick or hurt then your records will not be accessible for the doctors who are caring for you at this alternate location. An exception to the local area limitation is the Veteran’s Administration, which developed a program called VistA. The person who uses VistA will find access to his VA records very easily at any location he may be [9]. The major reason why access to EMRs are not geographically favorable is because very few standards exist. Systems in one city can’t talk to systems dispersed in other locations; the databases that EMRs use are not accessible by multiple systems. Another limitation of EMRs is that security is a major concern for all. There are no systems in the world that is entirely secure and threat free. With EMRs, patients have very little say in participation so even if they have problems and concerns about their health records, there is almost little to nothing they can do about it. A standardized language is also needed if we want to fully maximize our use of EMRs. The AAMA states that one of the most striking disadvantages to an EMR is the lack of a standardized record-keeping and language system for documentation. An electronic medical record is not beneficial or effective if some of its users are unfamiliar with medical terminology used on a discretionary basis.

Privacy as well is a similar concern for patients using EMRs. HIPAA, the Health Information Portability Accountability Act, federal law, determines how health information may be shared electronically. With this law there are very good opportunities for sharing information, but also creates many problems when someone other than you wants to access your health records. It’s good if the person trying to access isn’t being allowed too access those records. It’ a major problem if someone close or a healthcare proxy wants to access the records. Another privacy concern is the fact that most of the applications that EMRs use don’t fall under HIPAA constraints themselves. A patient’s records are kept in a type of format on computer server that are owned and operated by a totally different company. The problem is that the company does not have the same restrictions as the healthcare professionals, therefore they can do what they want with your records and even share patient information [10]. There are about 13 different components of EMR and each one is very important to the patient. The first component is the progress entry note. This is used for free text entry when a patient gets checked on. It uses MEDCIN terminology as well as customizable specialty or disease specific templates. The next component is integrated patient management. Or interface for patient scheduling. The third component allows for scanning documents and images into the EMR as well as handwriting recognition for pen-based input. The patient call log, which is the next component, is for nurses and physicians to document calls, with an audit trail. The fifth component is health maintenance, which gives physicians the ability to customize mammograms, PAP, smears, Lipid, INR, Statins LFT monitoring at user-defined intervals and to track when they are due. The next component up is the order entry for labs and imaging, which uses CPT and ICD9 codes followed by the lab and radiology interface component, which uses the HL7 standards.

The eighth component is prescription management, which includes allergy alert with manual override. The ability to send Rxs directly to Pharmacy, insurance formulary, and frequent updates to medication database with side effects and customizable patient handout. This is followed by E/M Coding component with regularly updates CPT and ICD codes. The ninth component is consult letters and tracking for pending consults. This is followed by the communications component. This adds the ability to enter data using a handheld. You can access your EMR remotely safely and securely as well. One of the most important components is backup. This gives us the ability to backup to tape, CD, RAID, NSD, incremental, offsite with reliable disaster recovery. The very last component is simply the HIPPA compliance [11]. Some of the most popular companies that implement EMRs are Allscripts, eClinicalWorks, GE Healthcare, MedComSys, Medinformatix, NextGen, Physician Micro Systems, and Synamed. All these companies take advantage of having an integrated PMS beside MedComSys. PMS stands for Practice Management Systems which is a category of software that deals with the day-to-day operations of a medical practice. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.

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