The State of the Electronic Medical Record

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The quest for more immediate access to patient images and information to enable faster, critical diagnostic decisions is the goal of all healthcare providers. Anytime, anywhere access to all patient information is the newest Holy Grail across the healthcare enterprise.

To help in that crusade, radiologic images increasingly have become an integral part of the electronic medical record (EMR), progressing from the EMR's traditional use as a text-based diagnostic report with few, if any, patient images.

"Today, the EMR includes that [text-based] component, plus images from radiology, cardiology and other 'ologies' that have imaging modalities," says Richard C. Howe, Ph.D., vice president of IT consulting for VHA Inc.

Howe credits the Integrating the Healthcare Enterprise (IHE) initiative - the joint venture between the Radiological Society of North America (RSNA) and the Health Information and Management Systems Society (HIMSS) - for heightening awareness among healthcare providers beyond the radiology department to the value of electronic images in a patient's EMR.

"The vendors also have developed open architecture systems, which include PACS that allow all physicians to view images, not just radiologists," Howe adds.


The ultimate goal for many practitioners is to have EMRs become a cradle-to-grave record of a patient's medical history. As is the case with all technologies, healthcare institutions prioritize available dollars with the most immediate need. Providers that can invest in EMR technology see it as a vehicle to more informed patient-care decisions.

EMR Vendors: Product(s)
  • A4 Health Systems: HealthMatics EMR
  • Agfa Healthcare EMR MedAr
  • Cerner: PowerChart
  • eClinicalWorks: eClinicalWorks EMR
  • Eko Systems: Frontiers
  • Electronic Healthcare Systems: CareRevoluiton
  • Emageon: Enterprise Visual Medical Record
  • eMDs: eMDs Chart
  • GE Medical Systems Information Technologies: Centricity
  • HealthMedX: eWorkflow, WebCare
  • IDX Systems: IDX Carecast
  • Impac Medical Systems: Impac EMR
  • LAN Vision: accessANYware
  • McKesson: CareEnhance
  • Medical Manager Health Systems: Omni Chart, OmniDoc
  • MediNotes: Charting Plus
  • MedPlus: ChartMaxx
  • Misys Healthcare Systems: Misys EMR
  • Patient Care Technology Systems: Amelior ED
  • Physician Micro Systems: Patient Records
  • PowerMed: PowerMed EMR
  • Siemens Medical Solutions USA: Soarian
  • Vital Works: Intuition EMR, Ingenuity EMR, EMstation
  • Wellsoft: Emergency Medicine

"It speaks to how we spend the money as a community, a country and a people," says G. Daniel Martich, M.D., executive director of the EMR initiative at the University of Pittsburgh Medical Center (UPMC). "We have limited resources. We need to be smarter about them. We want to provide the best care possible without overtly rationing healthcare. One of the ways of doing it is being more efficient as doctors, nurses and hospitals."

UPMC plans to allocate some $400 million over 12 to 14 years to implement its IT infrastructure, which includes EMRs. The hospital is four years into that plan and has approximately 500,000 patients in its EMR data banks.

UMPC's Children's Hospital has created EMRs for its young patients, not necessarily from birth, however, because it is a children's, rather than obstetrics, facility. While it may not be the cradle-to-grave approach per se, Martich said it is at least the beginning of a life-long patient record for children who are two- and three-years-old.

"I think the potential [for a cradle-to-grave patient record] is there and it is starting to get that way," he adds. "Unfortunately, only time will fully bear that out."


Needless to say, not every healthcare provider has the financial fortitude to install a systemwide EMR. Capital budgets are based, in part, on - like it or not - the return on the hospital's investment (ROI) in a particular technology.

"There is a limited pool of capital dollars and constituents are competing for those capital dollars," says Patricia Whelan, vice president of IT for Shields Health Care and partner in Shields Consulting for radiology informatics. She also is the former director of radiology informatics at Massachusetts General Hospital (MGH) and former CTO of MGH's Radiology Consulting Group. "[An EMR] is often looked at differently than other initiatives, because it doesn't have a direct positive ROI from the system's implementation. It competes with initiatives, such as adding a new MRI, which will bring hundreds of thousands of dollars into the organization."