The idea of recording patient information electronically instead of on paper –the Electronic Medical Record (EMR) –has been around since the late 1960’s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice. Until then, doctor’s usually recorded only their diagnoses and the treatment they provided. Weed’s innovation was to generate a record that would allow a third party to independently verify the diagnosis. In 1972, the Regenstein Institute the Indiana University School of Medicine, developed the first medical records system. Although the concept was widely hailed as a major advance in medical practice, physicians did not fly into the technology (http://www.medrecinst.com/uploadedFiles/MRILibrary/StatusReport.pdf). In 1991, the Institute of Medicine in the US recommended that by the year 2000, every physician should be using computers in their practice to improve patient care and made policy recommendations on how to achieve that goal (http://www.medinfo.ufl.edu/omi/docs/olmr/cpri.html).

However, it is estimated that EMR use is about 20% in the hospital sector in the US (less in Canada) and about 5% in clinics (probably about the same in Canada). Some studies report the major barriers to widespread EMR implementation. They analyze different criteria, among which the major ones are: the cost of EMR purchase; the adaptation time; the length of a patient encounter; the time required to record the encounter, etc.

Here are some data findings:

• Most patient encounters last about 7-10 minutes
• Typically 25% of the time is spent in documentation
• Physicians record an encounter in about 2 minutes
• current methods of data input are slow and tedious
• They need systems which are easy to use and which don’t require long learning curves
• Given current costs of about $10-20K per year, there is a long way to go to get to an acceptable price
• Inability to recoup investments in technology.

It appears that market suppliers do not make a distinction between physician needs and health care system needs. Although we expect that the two markets are likely to move alongside, they are different and distinct markets. Major customers for EMRs that are being developed with large amount of functionality and complicated methods of data input will not be physicians as they are only small beneficiaries of these systems. These current systems are about what to do, but not about what patient information is most relevant, what providers need to know to deliver good care.

The on-demand systems such as EMRian http://emrian.com aim to solve the above issues, by providing 1) Low Total Cost of Ownership TCO (you pay for the features you need); 2) Simple and comprehensive data input system; 3) No initial capital investment and no maintenance and upgrade fees.

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