Last weekend, Aron, a professor of medicine showed me the Electronic Medical Records (EMR) system used at his hospital. This is not simply a way to electronically store information that used to only be on paper. It is an incredible step towards better medicine.

His laptop has a touch screen that allows him to quickly check boxes, which is how he enters most of the information during a visit. Aron showed me some hypothetical cases that he created to use in the classroom.

In one case, the patient had diabetes and high blood pressure and was obese. The medical record included a diabetes management module that asked for more specific information about the patient’s diabetes. It included recommendations for tests to order and the results of tests that had already been run. Using evidence based medicine criteria and the information in the medical record, it calculated the patient’s risk of heart attack.

The medical record included a list of all the patient’s medications and made it easy to find and prescribe drugs for the patient’s ailments.

In short, good medical records systems help physicians manage patient care more effectively.

If the data from electronic medical records is shared with hospitals, provider networks and insurers, the electronic medical record can have even more value:

• Provider profiling can compare apples to apples, because the medical record will show how ill the patient is and what was done to manage their care.
• Treatment and test effectiveness can be measured on a large scale in real-time, because diagnosis, treatment, and outcomes will be stored in the same system.
• Billing will be more accurate, because it is easier to link the care given to the bill submitted.
• Targeted educational materials can be distributed to physicians and patients.

The advent of electronic medical records will also change the way fraud is committed and the way it is detected.

Fraud perpetrators will have to provide more information to commit fraud, but the systems may help guide them to that information. For example, it will be easy for us to check if the medical record indicates that a patient visit meets all the criteria for a 99214 office visit. Does the patient have high risk of complications, morbidity, mortality? Were evaluations done of several major body systems? The systems will guide the physician to bill the correct code, so there will be fewer honest errors.

However, it will still be possible to trick the system. It will just take more work. Physicians wanting to upcode can click a few more check boxes and get a higher paying code. To submit a claim for a service that did not occur fraud perpetrators will have to fabricate or steal a lot more information than they do now.

If fraud perpetrators take the time to create phony medical records, our current methods of finding fraud may be ineffective. We’ll need to look for new methods, that involve looking at different data than we usually review. For example, computerized timestamps will be an important clue to whether a service actually occurred.

On the whole, medical records will make it easier for healthcare providers to serve their patients effectively. It will reduce medical errors and billing errors. It could improve the way we detect fraud and lead to faster recoveries. It will not end fraud, but it will dramatically change the way we look for fraud.