But emergency rooms, hospitalizations, outpatient visits and doctors offices are only the broadest strokes when it comes to
painting a customized medical record presentation. "We have about 70 specialists," says Dr. Walker. "Each one of those specialists has different, customized EHR views. We don't
hide anything, but we bring the most important information for them to the forefront." Dr. Walker says Geisinger's customization of its patients' electronic records is not typical. "It takes an enormous amount of work, and because of that, a lot of organizations don't do it," he says. "But we think it's
critically important to the quality of care and efficiency." OBSTACLES LOOM According to a recent New England Journal of Medicine (NEJM) survey of 2,758 physicians, only 4% have extensive, fully functioning electronic records systems, and only 13% have
even basic electronic systems. However, adoption rates are expected to climb quickly. Sixteen percent of respondents to the NEJM survey had purchased but
not yet implemented electronic health records, and 26% of respondents said their practice intended to purchase an electronic
record system in the next two years. As those soon-to-be adopters evaluate EHR software, one of their criteria should be EHR
data customization. "Everyone involved has a different perspective," Dr. Walker says. "What you want is a team approach where all parts of the
EHR work together. If you start with that idea, then the information system you choose is going to look different. What many
look like now is something that helps one person, but doesn't take into account what others need." Ultimately, it's up to software vendors to create EHR systems that satisfy everyone's needs. "Even the organizations that are the furthest ahead with EHR have a long way to go before we say, 'Yes, this is optimal,'"
Dr. Walker says. "If you do it right, you have to change almost everything about the way you work. People think buying an
EHR is like buying a word processor. It's not like that." Making sure that different healthcare providers have the information they need at their fingertips is a critical national
goal, according to Ury. "We're making slow, but real progress toward it. Right now we're a system in transition," he says. Jamie J. Gooch is a Cleveland-based freelance writer.
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