John A. Marcille

Time. For most of us, it's among the most precious commodities. Anything that gives more time than it takes, and doesn't cost too much in other commodities (money, prestige, honor...) deserves our attention.

Will the automated medical record give more than it takes?

In this month's cover story, starting on page 10, writer Jean Lawrence addresses many of the issues raised by this concept and gives us a snapshot of how several institutions are trying to reach the goal of a comprehensive, automated patient record.

But is it a worthy goal? Assuming, perhaps rashly, that issues of confidentiality can be satisfactorily resolved — and I mean in a way satisfactory not just to the health care community but to patients and others who could suffer from inappropriate dissemination of medical records — having a patient's complete medical record available to a physician at any time, at the hospital or in the office, with minimum fuss, will contribute greatly to improved care for individuals and populations, reduced errors and ultimately (not immediately) reduced costs.

To make the AMR a reality, everyone must benefit. Programmers need to look beyond the obvious. It's a fine thing to promise "decision support," but if it works as well as the spelling checker in our "state-of-the-art" word processing program, which usually questions perfectly sound usage and misses actual errors, physicians will be rightly irritated.

Under pressure to increase productivity, they must not be saddled with systems that slow them down, except for a minimal — really minimal — period to learn the system.

Don't look for the fully automated medical record any time soon. You'll find comprehensive records available on-line in a hospital or physician's office or, of course, a group- or staff-model HMO, but when care is rendered in many locations, especially ones contractually unrelated to the patient's health plan, the automated medical record is still a dream.