Open source EMR programme can stimulate doctors to embrace computerisation

Philadelphia 06 November 2000A recent survey of nearly 10.000 doctors of internal medicine has found that physicians have not yet fully embraced computers for the practice of medicine. According to Hayward Zwerling, M.D., FACP, forty percent of physicians abandon their newly purchased Electronic Medical Record (EMR) software within one year. As a practising internist and endocrinologist, Dr. Zwerling has designed his own EMR programme over the past ten years. At present, Dr. Zwerling's ComChart is available as an open source EMR, born out of the daily medical office routine. Physicians can customise this freely downloadable Computerised Chart system and match it to their individual needs.


Dr. Zwerling began writing and using his first EMR in 1991 and soon found out that this EMR could help reduce filing and dictation costs. Among the 10.000 surveyed internists however, only six percent consulted a computer-based information source when with a patient in an office setting. In hospital settings, physicians used a computer to access patient medical histories 25 percent of the time, notwithstanding the fact that 82 percent of the respondents reported that they regularly use computers for personal or professional medical reasons.

The survey equally revealed that despite using the computer for e-mail in the office by some 58 percent of the respondents daily, only seven percent of the physicians surveyed exchanged e-mail with the patients on a daily or weekly basis. Patient records, too, are not likely to be computerised, with 19 percent of internists admitting though that their practice was partially or completely computerised for patient records. Obviously, there exists an urgent need for a programme like ComChart, that was designed to enable doctors to interact with the computer in a manner which is similar to the way they interact with the traditional paper patient record. In addition, ComChart affords the user additional capabilities which can not be obtained from a paper record, as Dr. Zwerling explains.

In the survey, respondents rated their own computer skills as average, and expressed the intention to increase their general computer skills as well as enhance their knowledge of computer-based information sources for patient care, EMR systems, computer-based CME, and telemedicine. Dr. Zwerling believes that there are many physicians who have the technical background to write their own EMR. A physician's medical record is a reflection of their practice style, which can not be met by a commercial EMR. ComChart's open source philosophy enables the doctor to add modules, subroutines, change the graphical user interface or otherwise alter the software to guarantee that it meets the practice's needs.

The results of the conducted research are contained in "Computer Use and Needs of Internists", a paper based on a technological survey undertaken as part of a general survey of members of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), the largest medical speciality society in the USA. The report reflects the responses of 9466 physicians to 198 questions. The paper was authored by current and former ACP-ASIM staff members, including David A. Lacher, M.D.; Elizabeth A. Nelson, Ph.D., RN; Wayne Bylsma, Ph.D.; and Robert P. Spena, DSW, and presented at the annual symposium of the American Medical Informatics Association (AMIA), held in Los Angeles from November 4 to 8, 2000.

Dr. Zwerling's current version of ComChart can run on any contemporary Macintosh or Windows computer. It can be networked up to 250 concurrent users or run from a Web site. For doctors who need to have their version of ComChart modified, and are unable to do it themselves, ComChart will offer customised programming for an hourly fee. You can download ComChart at For further information, details, and questions, you can directly e-mail to Dr. Hayward Zwerling.

Leslie Versweyveld

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