The EHR Debate: Fighting the Last War?

The EHR Debate: Fighting the Last War?

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Right now there’s a fierce debate going on for the hearts and minds of health IT. Finally American health care (well, half of it anyway) is using electronic medical records. But it’s not the panacea we were lead to believe. Costs haven’t gone down, health hasn’t markedly improved and the taxpayer/Chinese government is poorer. So too are many doctors and hospitals, and the main beneficiaries appear to be construction companies in Madison, Wisconsin.

Worse, those who promote the impact and importance of EMRs (Farzad MostashariAshish Jha) are being attacked by Ross Koppel, Steve SoumeraiScott SIlverstein and others who essentially say that EMRs are more dangerous and inefficient than paper.

This reminds me of the World War One British Army preparing to fight in the mud of Flanders with cavalry charges suited to the Boer War, the French Army in 1939 retreating to their WWI style trenches while the Germans flew over them, and (dare I say it) today’s TSA strip searching grandmothers looking for boxcutters.

Yes, we’re having the wrong fight by focusing on old problems. The EMRs that are producing the studies we’re fighting about are the current equivalent of 1990s EPR implementations. In general they’re hard to use and require lots of money and training to produce halfway decent results. The real improvements from IT came when user-centered tools came to consumers and then to business with Web 2.0 and new devices like the iPhone.

It may take months of training on Epic or Cerner to get a doctor or nurse to be three-quarters as productive as they used to be, but my two-year-old daughter can fire up an iPad and play games and watch videos with no training.What we’re seeing every day at Health 2.0 is a whole new generation of data-driven applications and devices that are going to make the health care user experience much more like the one my daughter has.

When we get there, the real improvements in both productivity and safety, as well as in quality and even cost, will emerge and we’ll wonder why we ever were having this fight.

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146 Comments on "The EHR Debate: Fighting the Last War?"


Guest
S Silverstein MD
Jul 18, 2013

Re: ” those who promote the impact and importance of EMRs (Farzad Mostashari, Ashish Jha) are being attacked by Ross Koppel, Steve Soumerai, Scott SIlverstein and others who essentially say that EMRs are more dangerous and inefficient than paper.”

My actual position is that bad health IT (as defined at http://www.ischool.drexel.edu/faculty/ssilverstein/cases) is worse than paper.

I find studies such as the ECRI Deep Dive (171 voluntarily reported HIT incidents from 36 ECRI PSO member hospitals over just nine weeks, with 8 incidents of patient harm and 3 possible deaths) alarming in that regard. See http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html

Guest
Bobby Gladd
Jul 18, 2013

There’s a maxim among trial lawyers: “He With The Best Story, Wins.”

“worse than paper.”

Which paper? The worst, the most incomplete, illegible? The ones with coffee stain residues obscuring the lab results? The ones that get torn and taped over?

Did the ECRI thing, being, well, “scientific”and all, provide a paper chart control group?

Guest
S Silverstein MD
Jul 19, 2013

You conflate risk management-relevant case reports/studies \ with scientific research. More on that issue at http://hcrenewal.blogspot.com/2011/08/from-senior-clinician-down-under.html

Guest
Steve Soumerai
Jul 19, 2013

Who said that “EHRs are more dangerous and inefficient than paper?” Certainly not our blog. We have been talking about false claims of (debunked) cost savings, health gains and reductions in mortality from our trillion dollar investment in HIGHTECH. As Ashish charged in his post on our WSJ piece (it’s too late to go back to paper), this is just putting words in our mouths. A straw man? We are talking about the effect of a rushed and poorly managed nationwide boondoggle.

There isn’t one piece of evidence in Matthew’s beautifully written! anecdote to justify his conclusions. Do we now want to throw more money after bad in the absence of decent data that new technologies will work? Or can we learn from our past mistakes and proceed incrementally with fully disclosed conflicts of interest once we know we have achieved something valuable. Or perhaps the term “evidence-based policy” is just a catchy phrase; certainly and sadly; it doesn’t happen all that much. Best, Steve S.

Guest
Steve Soumerai
Jul 19, 2013

Sorry folks. Sitting in 95 degree heat and it’s HITECH.

Supposed to reach 101 in Boston. How about others?

Guest
Jul 20, 2013

Evidence Steve? My daughter’s room yesterday 8.15 am: a life & death struggle to get the iPad out of her hands so I could take her to day care. Luckily not recorded on video so that Child Protective Services may not be altered….(although if they’d offered to remove her during the incident, I’m not at liberty to say what my answer would have been!)

And while I agree that HI(GH)TECH could have been done differently and that reliance on those old EPR style vendors (including the one that the major institution attached to your medical school just decided to spend over $1 billion on) is not something that we would want if we were starting from scratch, But we weren’t starting from scratch and this America where the job of Congress is to funnel money to already moneyed interests who want more money. Within that context I dont think HITECH was bad legislation and I do think ONC has done as good a job as possible making some stipulations for what the program has to do–which will get better with MU 2 & 3.

The real question–the next war–is how do we make what another Harvard project (SMART) is trying to do happen very quickly. If we get a real market for user friendly end-user applications that can use data from the big ERP like systems, we’ll get to the point where clinicians and patients will have attitudes closer to my daughter, rather than to the 34% of users who are currently looking to de-install and start again.

Guest
Raj Sharma
Jul 21, 2013

@Blogger_Holt,

Do you use the EHR and CPOE systems that you defend?

Easy for the arm chair lay people to think they understand what is involved with the care of sick patients.

If you know so much, inform us of the incidence of crashes and outages and their duration.

The truth would be shocking.

Guest
Al
Jul 21, 2013

Steve S., you hit the right word, incremental steps, but when has the government ever been incremental permitting organic forces to create the EHR?

Guest
Jul 18, 2013

Excellent piece Matt. Yes there is bad health IT. I can even imagine how it could be worse than paper, though that’s a pretty tough. Bottom line is that we have to go digital. We can’t achieve any of the goals we have for a more efficient and effective healthcare system without health IT. The next war is about how to make health IT better — and have a healthcare delivery system that is flexible enough to exploit technology to deliver better care.

Guest
S Silverstein MD
Jul 19, 2013

re: ” I can even imagine how it could be worse than paper, though that’s a pretty tough”

Ashish,

See http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html

Guest
Phil
Jul 21, 2013

A press release from a nurse’s union that has been in a bitter labor dispute over the past 2 years with the hospital and has gone on strike 9 times….surely a questionable source.

Guest
S Silverstein MD
Jul 22, 2013

Actually, I’d take the word of unionized nurses on risks to patients over the word of hospital and IT executives, and ‘egghead’ hyperenthusiast morals-are-relative academics lacking real-world experience anytime, based on experience as medical safety manager for a large highly unionized public transit agency many years ago. The unions had petty issues for sure, but they certainly did not want train wrecks.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 18, 2013

Yeah, it didn’t work so well last time, but it’ll work next time. Yeah, that’s the ticket.

Guest
Bobby Gladd
Jul 18, 2013

Paper is clearly better. After all, everything that COULD be invented has by now been invented.

Guest
40yearold doc
Jul 19, 2013

“Paper is clearly better.”

Yes, for out-patient care, a well-organized paper chart and a highly trained staff IS better than current EMRs combined with MU.

Guest
SJ Motew, MD
Jul 21, 2013

So how do you retrieve from your stack of paper charts the list of all patients with ASCVD who are not on ASA (and need to be) so that you can impact their health? Or how do you show the payers each year (in order to be paid fairly) that you can manage diabetes well in your patient panel by showing them that your average HBA1C is < 7 from your paper charts?

Agreeably a long way to go and grand cluster without standardization but certainly not even comparable to paper.

Guest
S Silverstein MD
Jul 22, 2013

How? Via data entered into registries by paid clerical data entry clerks, thus using clinician time appropriately and not wasting it on clerical duties. This comment is not theoretical as I designed an invasive cardiology information system for one state’s only tertiary care hospital in exactly that way, The hardest part of that project was steering around the IT leaders’ incompetence. http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story

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40yearold doc
Jul 22, 2013

I don’t give a flying f*** about showing payers anything. That’s not what I consider my job as a physician.

I tell patients with ASCVD to their faces when I see them in the office or hospital to take ASA. That’s how I “impact” their health.

Guest
SJ Motew, MD
Jul 22, 2013

40yrold…I suspect you will care about showing payers when they reduce or stop paying you.

SSilverstein…Interesting, I don’t use anyone to enter most of this data which is entered directly from the pharmacy and lab. Someone (i.e. you) is putting list of meds, allergies, past history into your paper chart, isn’t this clerical work??

Guest
40yearold doc
Jul 22, 2013

“40yrold…I suspect you will care about showing payers when they reduce or stop paying you.”

So the whole point of EMRs is to enable physicians to jump through arbitrary payment hoops? Count me out.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 20, 2013

Actually, I’m all for the development of EMRs. I just don’t want them *deployed* until they are proven more effective, efficient and safer than paper. I use EPIC now, and I am not convinced.

Guest
BobbyG
Jul 20, 2013

EPIC. Well…

Condolences, bud.

“just don’t want them *deployed* until they are proven more effective,”

And, that “proof” would comprise precisely what?

Guest
Craig "Quack" Vickstrom, M.D.
Jul 20, 2013

Probably an the EMR working in parallel to paper and Dictaphone, for at least a year. Showing me that I can see more patients, faster with fewer errors and better outcomes. AND with less time spent documenting.

Guest
BobbyG
Jul 20, 2013

Craig “Quack” Vickstrom, M.D. says:
July 20, 2013 at 7:28 pm

Probably an the EMR working in parallel to paper and Dictaphone, for at least a year. Showing me that I can see more patients, faster with fewer errors and better outcomes. AND with less time spent documenting.
__

CHANGE.THE.PAYMENT.PARADIGM

I know it escapes you, but I am on your side.

Guest
S Silverstein MD
Jul 22, 2013

Bobby,

If no such proof exists (or can exist?), as you seem to imply…than we are spending hundreds of billions of dollars on a technology of unknown risk (IOM’s words, not mine) to replace another technology, paper, based on “hope” that the latter is better and safer, and not on rigor and due diligence.

My colleagues and I find such views disappointing and highly misaligned to the ethical concerns prevalent in western medicine.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 21, 2013

It does not escape me. I have no way of doing it.

Guest
Jul 18, 2013

By the way Matt — I wrote a similar piece (http://blogs.sph.harvard.edu/ashish-jha/the-wrong-question-on-electronic-health-records/) after Soumerai and Koppel wrote their critique of Health IT in WSJ.

The question for Soumerai and Koppel is this — what’s the alternative? Keep the healthcare system we have? Its a mess. There’s much more evidence that Health IT, when done well, can improve care than for almost any other policy intervention.

Guest
S Silverstein MD
Jul 19, 2013

the alternative is to treat health IT as any other medical device, and roll it out slowly, safely, with regulation of its quality, post marketing surveillance, and so forth – or, as you put it, the next war is to improve health IT.

i agree, but it must not be done in situ while putting patients at risk, unless those patients are afforded meaningful informed consent.

Guest
Jul 20, 2013

I’m going to upset Scott by saying again, “just like in the Vioxx case”

Guest
S Silverstein MD
Jul 21, 2013

Matthew,

Actually, just like NOT in the Vioxx case.

See the piece I wrote on VIOXX and the potential use of EHR data (from good health IT, of course) written ca. 2004 or 5, “Reflections on the future of drug safety surveillance from the Medical Informatics perspective” at http://www.ischool.drexel.edu/faculty/ssilverstein/scotsilv/vioxx1.htm

I presented on that topic to Merck Research Labs’ adverse events & drug surveillance dept. ca. 2006.

IMO health IT should be subject to the same scrutiny that drugs are, or are supposed to be, before widespread deployment, and should be subject to post marketing surveillance as well. Yet there’s no database of EHR problems that can be mined to identify bad health IT.

Guest
Chris DeNoia
Jul 21, 2013

That is abdicating the health IT revue process to government and stifling to advances for a product that can be improved in iteration, realtime. The alternative to IT is paper, which already is subject to errors, misfiling, poor hand writing, and time delays.

One could imagine a doctor 20 years ago suggesting he could not use a fax machine without FDA approval to send a chart, an ambulance dispatch could not use the phone pending FDA approval of the use…

Guest
Al
Jul 21, 2013

” health IT should be subject to the same scrutiny that drugs are…”

You hit the nail on the head. These guys professing to believe in science only seem to use science when it is convenient to promote their agenda’s. Thanks.

Guest
Al
Jul 21, 2013

Let me revise my statement for Chris’s benefit. It need not require the review if government isn’t mandating it..

Guest
Jul 22, 2013

Apparently Vioxx and other withdrawn drugs never went through the vaunted FDA approval process Scott prefers. The went through some other imaginary process.

And BTW everyone serious (may even Scott) understands that the FDA approval process and that of clinical trials themselves is hopelessly unscientific (see Ben Goldacre’s work). And the “regulation of its quality, post marketing surveillance, etc” that Scott thinks Health IT should go just doesn’t exist in any practical sense for drugs or medical devices. But keep going down that delusional path, Scott and ignore the potential to improve what we have now but getting new technology into the system.

Guest
Al
Jul 21, 2013

Ashish J., why do you say there are only two alternatives available? There are other ways and one of them is for EHR’s to grow organically while the government and the experts get out of the way.

Do government or the experts know how to practice medicine outside of the laboratories of the Universities?

Guest
Curly Harrison, MD
Jul 18, 2013

There has been a strategy to avoid the evaluation for safety and efficacy of HIT that all other medical devices undergo.

Jha states: “There’s much more evidence that Health IT, when done well, can improve care than for almost any other policy intervention.” What is the evidence exactly, and might it just be hearsay?

Good doctors are impeded by HIT, and have been for about a decade. You do not hear about this because the doctors’ opinions are quashed by threat of retaliation and depreciation.

The national HIT experiment is a failure so far: zero improvements in outcomes and costs, while innocent guinea pig patients have been killed.

Guest
Bobby Gladd
Jul 18, 2013

Pul-EEZE. Cite actual grown-up, rigorous data.

“Doctor”

Guest
S Silverstein MD
Jul 19, 2013
Guest
Dr. Mike
Jul 18, 2013

Where is my ipad/android EHR? I want it and I want it now! If it also runs on a non-touch screen device I DO NOT WANT IT! It has been how many years since the Ipad hit the scene? Why isn’t it here yet????
/tantrum off

Guest
Jul 20, 2013

DrChrono, Allscripts WAND, and a few more

Guest
Dr. Mike
Jul 20, 2013

DrChrono appears intersting, Allscripts WAND not so much as it appears limited by it’s desktop DNA.

Guest
Whatsen Williams
Jul 18, 2013

I like the report by the nurses exposing the nitty gritty on health IT, ie, that it endangersbthe care of the patients. Why is there a notion that if medical care requires a computer to guide it, that it will be safer and better than the system of care that was replaced? Paper as the medium for creating notes and the story of the patient is provocative. Computers are too rigid in what they allow the creative clinician to do.

Guest
Bobby Gladd
Jul 18, 2013

Retire. If you are even a physician. A “report”? What “report”? What does it scientifically “prove” or, less dispositively “indicate”?

Get serious here.

Or not.

Guest
S Silverstein MD
Jul 22, 2013

Bobby,

Are you a physician or have any clinical training or experience? I know Matthew doesn’t, and I tolerate his antics because they amuse me, but you telling physicians to “retire” lacks any amusement value at all and is actually getting into the realm of needlessy rude.

Guest
BobbyG
Jul 22, 2013

Ahhh…. the tried and true insinuation “if you’re not a physician, you have no right to any views on Health IT.”

Notwithstanding, I in fact have been erring over into the “needlessly rude” of late. My apologies. I shall try to get a grip and do better.

But, I note, you did not respond to the meat of my query. What “report”? What does it objective purport to “prove” that rises to encompass the broader HIT issue?

Guest
S Silverstein MD
Jul 22, 2013

Actually, my view is that without medical training and experience, one’s views on health IT are those of an amateur. Everybody is entitled to an opinion, of course, it’s just that informed opinions have more credibility than those of amateurs. (Note – that is not a pejorative term. i am a radio amateur a.k.a. ham and although hold the Extra class – the highest licence – by exam, i am still a radio amateur and not a telecommunications professional).

Case in point…you and Matthew would not be permitted to testify as expert witnesses in health-IT related cases, while I and similarly educated physician informaticists are, and do.

Opine on, but show some humility based on lack of relevant education and experience.

Guest
S Silverstein MD
Jul 22, 2013

and I was not responding to an issue about “reports”, merely your insensitivity and rudeness to the audience of this blog.

Guest
ytisebo
Jul 19, 2013

Holt says: “… others who essentially say that EMRs are more dangerous and inefficient than paper…”

Not exactly from my read. The data to support the use of HIT other than digital labs and images is flimsy at best, yet the vendors and hIMSS convinced Congress to spend $ billions. The costs have gone up and outcomes have not improved. All the while, no one is recording the deaths and other adverse events from the errors cuased by the systems in question.

Guest
Caregiver, MD PhD
Jul 19, 2013

@Holt: “It may take months of training on Epic or Cerner to get a doctor or nurse to be three-quarters as productive as they used to be, but my two-year-old daughter can fire up an iPad and play games and watch videos with no training.”

Read Foote in JAMA at Dartmouth. The systems are an insult to health care professionals who now must guard against errors faciliated by the complex ordering systems with idiosynchrasies worse than the disease being treated in the patient.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 20, 2013

Amen.

Guest
Roger
Jul 19, 2013

There should be a forensic study similar to thisin Australia: http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html

Guest
LegacyFlyer
Jul 19, 2013

So lets see:

– EMRs slow down docs and nurses (which drives up costs)
– They can’t talk to each other (fundamental design flaw – unlike DICOM)
– No evidence they improve care
– No evidence they save money

But the government is mandating them and forcing their adoption. And some EMR vendors are making tons of money.

And this is progress?
Did someone make some big campaign contributions?

Guest
BobbyG
Jul 19, 2013

Judy Faulkner

Guest
legacyflyer
Jul 19, 2013

Judy Faulkner?

And your point is?…..

Guest
Know it all
Jul 21, 2013

Who is Judy Faulkner?

Guest
Jul 21, 2013

Judy Faulkner = Founder/CEO of EPIC

Guest
Jul 19, 2013

As Matthew states, today’s EHR systems have their roots in the 1990s. Further, those systems were never designed to offer sophisticated decision support or to be responsive to clinical workflows. As a result, we have EHR systems that do not meet the needs or expectations of clinicians. The frustration that clinicians feel is understandable. However, exactly how one should go about building better EHR systems is not obvious.

Building EHR systems with adjustable workflows, easy to use reporting and population management tools, and sophisticated decision support requires, among other things, the rendering of complex clinical concepts in a computable form. Obviously, this is much easier said than done. Research on EHR design and architecture has been left pretty much in the hands of vendors. Thus, while we have an open discourse on issues such as data exchange, terminologies and coding systems, there is very little formal research and open exchange of information regarding how to build EHR systems. As an example, the HL7 EHR functional model specifically disclaims any intention to say how proposed functions should be implemented in actual EHR systems.

We have no idea of what the best EHR database schema is, or how to best represent clinical workflows, or the best way to incorporate workflow engines in EHRs, or the optimal user interface architecture/design. Most of today’s EHR systems were conceived at a time when LAN-based client/server was state-of-the-art and reliable relational databases were becoming affordable for small businesses.

The cloud as a computing concept is really only about seven or so years old. The REST architecture, proposed in a PhD dissertation in 2000, is just now catching on. NoSQL data stores are now available that offer new data management capabilities. Finally, the iPhone was introduced in 2007 and the iPad in 2010 (to a mostly skeptical public). Moving software from a mouse-based interface to one based on touch is not trivial. Clinical software has a lot of catching up to do. This is neither a criticism nor an apology; it is simply a fact. Safety is critical and should be a component of any certification process.

I am optimistic that EHR systems will improve. But, in order to do so, those on both sides of the issue must work together toward that goal.

http://ehrscience.com/2013/04/22/ehr-design-and-personal-work-habits/

Jerome Carter, MD

Guest
S Silverstein MD
Jul 19, 2013

What about patients whose care is subject to these medical devices during the “improvement” phase? Or should the health IT and hospital industries be given carte blanche to get the bugs out on live patients?

That has been the unprecedented special accommodation afforded the health care/health IT industry.

The software in the 777 you travel in was not tested and debugged on the Washington-to-San Francisco run.

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BobbyG
Jul 19, 2013

“The software in the 777 you travel in was not tested and debugged on the Washington-to-San Francisco run.”
___

Yeah, Scot, we all know that ALL avionics software works perfectly, first time, every time.

What dod you want? A total HIT operations moratorium until ALL bugs and sub-optimal usability features are ID’s and removed to your satisfaction?

Wish in one hand…

Guest
Craig "Quack" Vickstrom, M.D.
Jul 20, 2013

That, is exactly what i want.

Guest
S Silverstein MD
Jul 21, 2013

Bobby G, what you wrote is an example of an appeal to extremes.(Erroneously attempting to make a reasonable argument into an absurd one, by taking the argument to the extremes). Logically fallacious.

Guest
BobbyG
Jul 19, 2013

“I am optimistic that EHR systems will improve. But, in order to do so, those on both sides of the issue must work together toward that goal.”
__

Tell it to the naysayers that overpopulate these comment threads. It must be PERFECTION out of the box in every way, or “paper is better” (which the latter is not)

Guest
legacyflyer
Jul 19, 2013

“PERFECTION out of the box in every way”

How about in one way?

Guest
S Silverstein MD
Jul 21, 2013

Straw arguments.

Guest
Jul 20, 2013

I think that the major EHR problems are in a different area. Medicine is not a precise science and two physicians of the same specialty and even within the same practice work differently. The traditional software has their algorithms built-in to fulfill the current requirements. This approach works well in e.g. accounting where rules are all the same and do not change as often as in the healthcare. Also the software designers are more concentrated to fully address the formal requirements (to get all the required certifications) than on making their product convenient and efficient to use. The above is not as much dependant on technology achievements as on the way of how people think. The software intelligence solutions I have developed may work equally well within the old client/server and cloud based technologies. One of the main problems I have encountered is deficiency of physicians who want to contribute time and efforts to tweak the system to work well in their specific environments. There are way more doctors who like to whine and complain than those who want to make an effort to change both – the software and their habits.

Guest
Jul 19, 2013

As presumptuously it may sound, but I have an answer to all of you. And the answer is software intelligence. Here is what one of my customers said: “Having evaluated numerous EMR products and platforms over the years, I was consistently promised by almost every EMR company I looked at that I would save time, get home quicker and reduce my overhead compared to working on a paper chart. Having been an EMR user since 2001, despite my efficiency as a typist (I can type 100 wpm) and my proclivity towards computers and technology, I was never able to personally realize any of the above promises. The only thing my EMR did for me was create a neat looking document that I could conveniently reference from home. With every 15-30 minute patient encounter I am allotted, I found myself spending at least half of each encounter entering data, struggling to find test results and fumbling with orders rather than directly interacting with my patients. On top of that, I found myself often staying in the office late to finish my electronic charting. Having shared my frustration with numerous colleagues across the country, I found that I was not alone with regards to dissatisfaction with my EMR and eventually resigned myself to the idea that EMRs could only do so much.
That opinion changed when I was introduced to EMA in January of 2012. After viewing a demo and a brief chat with EMA’s creator, Boris Katz, I found, for the first time, a product that had the potential of legitimately fulfilling everything my EMR company had promised me years ago. I can honestly say today that compared to working on a paper chart (or anything else I have tried), I am now able to save time and get home earlier while improving the quality of my face time encounters with my patients. This applies to both patients with simple as well as challenging diagnoses. Equally important, especially during these challenging times of dropping reimbursement, our single specialty practice of 5 gastroenterologists has been able to reduce our medical assistant staff by a full FTE (a savings of about $50,000 per year) which we attribute almost exclusively to EMA. The exciting prospect for us moving forward is that as Boris continues to refine EMA for our practice, we expect our efficiency to grow further!

Roy L. Foliente, M.D., AGAF”

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Whatsen Williams
Jul 19, 2013

I ponder why patients are subjected to medical care run by software driven systems that not only have not been tested for safety, but have no accountability to any agency when they cause serious adverse events and facilitate errors. I smell a dead rat.

Guest
BobbyG
Jul 19, 2013

Specify quantitatively the “safety” errors or STFU.

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legacyflyer
Jul 20, 2013

BobbyG,

Top of the morning to you sir. Your style of debate is sure to win friends and influence people – NOT.

Generally in Medicine, when one moves from the traditional way of doing something to a new way, one is required to demonstrate that the new way is superior. We don’t adopt something that someone THINKS is great and then demand that others prove that it is not.

It seems that you have turned this principle on its head. Now the EMR skeptics need to quantify the errors or STFU? Really?? How about a demonstration of safety and efficacy from the proponents before we adopt it?

The traditional way of keeping medical records was on paper. Then (quite reasonably) it was proposed that we should move from paper to electronic documents.. In principal I also believe that medical records should be electronic. However, in practice it has not worked out so well. At present, there appears to be no demonstrable benefit to and EMR. Yet we are spending tons of money and coercing people to buy systems that they will soon have to replace.

Years from now, I believe we will all be using well designed electronic medical records. The journey from where we are now to there will be difficult and expensive.

It is too bad that the Feds decided to proceed by : 1) Ready, 2) Fire, 3) Aim.

Guest
BobbyG
Jul 20, 2013

Yeah, that was over the top. Agreed. Very poor taste

“How about a demonstration of safety and efficacy from the proponents before we adopt it?”
__

What would comprise such a “demonstration”? It’ll never suffice for you guys.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 20, 2013

It’s going to be a challenge to satisfy us, I assume. Doctors are very hard to please.

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BobbyG
Jul 20, 2013

Craig “Quack” Vickstrom, M.D. says:
July 20, 2013 at 7:23 pm

“It’s going to be a challenge to satisfy us, I assume. Doctors are very hard to please.”
___

And they make a lot of mistakes not attributable to HIT.

But, you are correct. Want at least 12 opinions? Gather 10 MDs in a conference room.

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Dr. Mike
Jul 20, 2013

Do I remember correctly that you are a healthcare consultant? I would never, ever, hire a consultant who posted a statement such as this.

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BobbyG
Jul 20, 2013

“Do I remember correctly that you are a healthcare consultant? I would never, ever, hire a consultant who posted a statement such as this.”
___

Dude, I have been working around healthcare for 20 years. I am a statistical analyst by training and long experience, as well as an applications developer (Oak Ridge, radiation lab) back in the days prior to indoor plumbing. I am not a “healthcare consultant.” Health IT? Yes. Quantitative analysis? Yes. I cut my white collar teeth in a forensic environment — meaning you actually had to PROVE your assertions to an endless horde of hostile counterparties and regulators.

bgladd.com/papers

Part of my early QC training involved adversarial mock depositions conducted by our lawyers. And, I’ve been on the butt-end of some hostile audits that would make you yearn for a root canal without anesthesia.

What is your point? Docs DON’T err, independent of IT? See Groopman, Jerome, to cite one respected contrary source.

Docs are not hyper-opinionated? Right. It’s the unremarkable product of the Iron Man training paradigm. See “Medicine in Denial” by Messrs Weed, MD and PhD.

You just prove my point.

I’m plenty busy, my friend. There’s more than enough work to go around. I don’t sing in anyone’s choir.

Last year I got a 3 site, 14 doc Internal Med practice to Meaningful Use Year 1 Stage 1. It was not like herding cats, it was like herding cheetahs.

Guest
S Silverstein MD
Jul 21, 2013

Again, a fallacious argument showing no understanding of risk management principles.

Guest
BobbyG
Jul 21, 2013

Enlighten us then.

Guest
Doctor Mawrdough
Jul 20, 2013

Epiphany! Blogger Holt has seen the light when stating:

“But it’s not the panacea we were lead to believe. Costs haven’t gone down, health hasn’t markedly improved and the taxpayer/Chinese government is poorer. So too are many doctors and hospitals, and the main beneficiaries appear to be construction companies in Madison, Wisconsin.”

“Not the panacea. ” Exactly. You would never know that from hearing Mostasavy brag to the Senate and how the Senators sucked up his convoluted unsubstantiated conclusions with a “good work” sign off.

Scandalous, but Blogger Holt has finally come around to acknowledge that the Truth in HIT followers know what they are talking about.