From the Case Files of the Robert Wood Johnson University Hospital, Dec 2015

May 30-8:12pm: 27 yo teacher, Pam S., is out for her evening run. The delicious evening air fills her nose and lungs. She feels strong, healthy, and alive.

May 30-8:13pm: Pam pushes up a gentle hill. She feels sudden and severe pain, as if stabbed deep by a flaming splinter.  Pam stops, almost falling.  She struggles the mile home. The searing throb begins to fade. A long hot shower gives some relief.

June 3-5:45am: The torment progressed through the weekend and curled around pillows, drenched in sweat, she has not slept all night.  As traces of sunrise light frame her bedroom window, she decides to get medical care.

June 3-9:22am: Pam tells her story to her Primary Medical Doctor (PMD) and is examined.  Her pain is intense with any movement and he is worried. He orders blood work, pain medication and calls an orthopedic surgeon. The PMD completes his history and physical report, as well as his differential, in his Electronic Medical Record (EMR).  The note is transmitted instantly to the surgeon.

June 3-9:59am: STAT blood work is drawn at a lab down the street.

June 3-10:37am: Pam picks up the pain medication.

June 3-11:25am: The orthopedic surgeon reads the PMD’s note, listens to Pam’s story and examines her.  He orders an emergency MRI.

June 3-11:51am: The MRI is performed on the scanner in the surgeon’s office. The images are simultaneously sent to his desktop and to a radiologist, 85 miles away.

June 3-12:28pm: The surgeon is concerned about a possible mass on the scan. The radiologist calls the surgeon and confirms the presence of the lesion, and notes three others. The surgeon meets with Pam and explains the possible diagnosis. He also calls an oncologist, me, who agrees to see the patient that afternoon. The orthopod documents his findings in his EMR.

June 3-3:00pm: Even though Pam feels somewhat better from the pain med, she is frightened. She arrives at my office, carrying only the DVD of the MRI.  The electronic notes of the PMD, the surgeon, and the radiologist have been downloaded into our database.

June 3-3:51pm: After reviewing the records and doing a careful examination, I confirm the likelihood of cancer.  I am concerned about the apparent rapid progression of the disease and even though it is likely the illness can be cured, right now she is in danger. I recommend immediate hospitalization.

June 3-4:05pm: Understanding she may need complex therapy, and possibly urgent surgery, Pam requests that she be admitted to a hospital near her family in northern New Jersey, 47 miles away.  It takes 45 seconds to contact one of my partners in Regional Cancer Care Associates (RCCA), who works at that hospital. He accepts Pam as a patient and agrees to meet her in the emergency room, when she arrives.

June 3-5:27pm: Pam is at the hospital. Even though she has not yet checked in, the electronic notes of the PMD, the surgeon, the radiologist, the lab test results, the MRI images, as well as my evaluation with recommendations, are already in the ER, forming the base of her hospital medical record.

June 3-5:50pm: The curtain opens and her Oncologist, who has reviewed the day’s findings, greets Pam. She begins the road to recovery.

James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

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Gary LevinMighty CaseyJim SalwitzmaithriRob Recent comment authors
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Jim Salwitz

Thanks… I believe that if physicians are going to control the future of healthcare they must seize IT technology. From my standpoint if someone walked into my office today and said, “great news, we are returning to paper charts, can I get you a pen?”, the only thing I would sign would be my resignation.



Dr. Salwitz, In the time I read your reply, I dictated a brief office note on dragon and faxed it(on a fax/server) to a colleague paperlessly. As a matter of fact i can do the same thing on my cell phone! I dont need an emr to do that! My smart phone has better software than my emr! So let me get this straight, as you see it, my group payed hundreds of thousands of dollars for am emr system that slows work flow, does not allow me to see as many patients in a day as when I used… Read more »

Gary Levin

Within five years this will be the case ! Those who do not progress rapidly will no longer be in the system !!


I would be wiling to bet that many of those information exchanges you describe are merely the transmission of facsimiles of other providers work and not digital data that integrates with your emr. You dont need an emr to do that or anything else you described above! I can fax a paper record or email a pdf file of my dictation to you just as easily! You dont need an electronic medical record for that! I would be impressed if you could access her primary care physicians file at 3 am when the provider is not manually sending you a… Read more »


Not in my world it doesn’t. Offices in hospitals next door to each other cant communicate due to lack software compatibility. We have doctors here whose offices are IN the hospital, but the outpatient emr won’t communicate with the in hospital record. Put in another way, the data won’t even transfer WITHIN the same building! Even though we have the latest and greatest emr, If Dr Salwitz were to consult my group he would not be able to electronically send the record to me unless he faxed it! Hows that for cutting edge technology!

Jim Salwitz

Ron, I appreciate your skepticism. This is actually a true story that happened last Monday. That is why I wrote the piece, because it shows the potential of EMR based medicine. By chance the patient moved from caregiver to caregiver who had each fully implemented electronic systems. There reality still exists that even in my community, which has a large number of early adopters (our practice has been EMR based for 13 years), this was the exception, but it is an exception that shows the potential in such systems. In the end we will not be fully “EMR” based until… Read more »

Mighty Casey

WOW. Not a fable, fact? Wow. I’m gonna assume that every facility in the chain was on the same EMR system, ’cause that would have to be the case to have this interop fully, right?

And boy howdy are you right in your observation that “EMR” is just a dream until, like banks, the entire system works from a single database …


Wow, I love science fiction. The dream of what tomorrow’s technology may bring us. You forgot the part where the doctor drives home in the flying car we have all been promised! I guess it would have been great to have these features and inter connectivity BEFORE emr was forced upon us. No, that type of functionality isnt important to the bean counters and those who want to mine demographic data all under the guise of the promise of improved health outcomes and diminished costs, which are surely just around the corner(just like your nuclear fusion powered home)! Im sure… Read more »