Physicians

The Doctor Is In and Logged On.

ParikhWow. I’ve just taken care of three patients in 12 minutes, and I didn’t do it by “churning” them through my office as if it’s some sort of factory assembly line. Rather, those patients (their parents, more specifically — I’m a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter’s face; it turned out be nothing more serious than baby acne (it’ll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

In the past, these parents would have left a phone message and we probably would have spent the better part of a day or two playing phone tag. Or they would have had to make an appointment, strap their children into car seats, pack diaper bags and snacks and sit in a waiting room full of sick children — only to spend 5 to 10 minutes with me while I told them everything was fine. Instead, we fixed the issues by e-mail, allowing parents to stay in their lives at home and at work.

Such interactions are no longer a pipe dream for the future of medicine. This is how I (and several thousand of my colleagues at Kaiser Permanente in Northern California) practice medicine every day. In 2006, we implemented an electronic medical record system and haven’t looked back.

The advantages

Medicine is a multi-trillion-dollar-a-year business, yet most doctors still run it like middle-school students passing notes in a classroom: A doctor scribbles something on paper and passes it to a nurse or another doctor, who then scribbles something back. Later, somewhere on those same sheets of paper, another doctor will write something else that’s barely legible. It’s a primitive, fragmented and unreliable way to do business.

In my pre-electronic days, it wasn’t unusual to get an incomplete medical record because various parts were stuck in storage or older pages had simply fallen out.

Electronic medical records eliminate many of those fundamental problems — notes, orders and prescriptions are clear and contiguous. There’s no waiting for paperwork. And if a patient of mine shows up in another office across town (remember, Kaiser is an integrated system — we all share the same computer network), a doctor whom I have never met can see what I’ve written, my patient’s list of problems and what I’ve done for the patient in the past before he or she even sets foot in the room to talk to the patient.

Such record systems can alert us to possible medication errors or dangerous drug interactions. They can continuously be updated to identify best practices. And they talk to patients as well, allowing them to access past-visit information and immunization records and to make appointments and send e-mails to their doctor.

Finally, they help better integrate care. When a woman came to a routine eye appointment in our medical group, the nurse noticed a “preventive health prompt” in the patient’s medical record saying that she was overdue for a mammogram. The nurse booked her for a mammogram and, when the woman had it done a short time later, her doctors discovered early breast cancer. She was treated and remains well today.

Valid criticisms

All of this being said, electronic medical records have their critics.

In March, as President Obama was announcing his plans for healthcare reform, Harvard doctors Jerome Groopman and Pamela Hartzband wrote an op-ed in the Wall Street Journal questioning some of the records’ purported benefits. They wrote: “A study of orthopedic surgeons, comparing hand-held PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer — 48 compared to seven in the paper-based cohort. But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient’s weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.”

That’s a valid criticism, but these are data entry and vigilance errors by health professionals taking care of patients, the kind that can be remedied by holding doctors and others accountable for the accuracy of their documentation.

Other critics of electronic medical records have expressed concern about the security of computerized health information, and what happens to healthcare should a system crash. These too are legitimate concerns, but they’re no different than the ones in other industries in which data stability is critical, such as finance. We can’t imagine a world in which we couldn’t bank online, over our mobile phones or by using an ATM. Why should medicine be any different?

Electronic is better

Like most doctors, I’d like more time in my day to finish my notes or return the e-mails I receive each day. Electronic records don’t save me or my staff any time — medical assistants and others have to type in weights, measures and other data. Typing is nowhere near as fast as jotting chicken scratch.

On the other hand, I can time shift — if I want to be home by 5:15 p.m. to play with my daughter before she goes to bed, I can log in remotely and finish my work later.

Ultimately, getting away from a pen and paper is better for my patients. So though electronic medical records are far from perfect, you’d have to tear my cold, dead hand from the mouse to make me go back to relying solely on pen and paper.

Parikh, a Walnut Creek, Calif., physician, writes the Vital Signs medical column for Salon.com . This piece first appeared in the LA Times.

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free baby stuff AuJoejudyTom LeithLiz Means Recent comment authors
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free baby stuff Au
Guest

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Instead you have to suggest that there is more to you than meets the
eye and that he was not aware of this new interesting aspect of your
character. Using a facial mask on a weekly basis will
also add to the re-hydration process.

Joe
Guest

Good to see someone realizing the benefits of EHR’s

judy
Guest
judy

AND AGAIN SOMEONE IS BRAGGIN ON KAISER IT IS NTO A GOOD HEALTH PLAN IT IS PREVENATIVE NOT WANTING TO TAKE CARE OF OLD PEOPLE THEY DO NOT TREAT EVERY ONE LIKE THEY WANT THEM TO LIVE MY FRIEND GOES THEIR MADE THE REMARK NOW THAT SHE IS 78 THAT SHE HAS COME TO REALIZE THAT THEY DONT’ CARE AFTER 65

judy
Guest
judy

AND I AM NOT BEING MEAN, YEARS AGO MY FRIEND OF MANY YEARS MARRIED A WOMAN YES A MUSLIM AND HE CAUGHT HER IN BED WITH A MAN HE FILED FOR DIVORCE AND )YOUR RULES WERE FATHER OR BROTHER HAD TO KILL HER IF SHE GOT DIVORCE) SO THEY KILLED HIM WOW WHAT A WAY TO BELIEVE IN GOOD OLD RULES FROM COUNTRIES THAT ARE IN THE BIGGEST MESS IN THE WORLD AND THEY WANT TO MAKE OUR LIKE THEIRS

judy
Guest
judy

I would say your a Muslim like he is ? If I am right you would follow what he says> His Health care would never qualif for a GOOD Dr to pass Old People would have totell him as in HIM that we have to die page 425 so why in the world would a good American Dr. ever do any thing against the welfare of taking care of any one who is Ill. AND HE WON’T TAKE HIS OWN HEALTH CARE BILL AS HIS SO THAT IS ALSO A REALLY MAJOR THING THAT SAYS HE IS EVIL AS EVIL… Read more »

Tom Leith
Guest

> I wish that what is said to me as a patient were even
> parallel to what is said to the physician receiving
> the EHR.
> They use an EHR system that I found useful
> but, I’ve already found errors in the record
OK but don’t think these problems are absent (or even mitigated) in handwritten records…
t

Liz Means
Guest
Liz Means

I so agree with Pam Drew. I’ve been a health care consumer for almost 40 years due to IBD and other issues. I cannot even remember all the docs I’ve seen and finding old medical records would be an insurmountable task should they be needed. I’ve recently changed my primary care physician, so my primary and gastroenterologist are now in the same system. They use an EHR system that I found useful but, I’ve already found errors in the record after just a few months and entries that give rise to lots of questions. And things that made me go… Read more »

Pam Drew
Guest
Pam Drew

Comment on The Doctor Is In and Logged On July 20, 2009 THCB Dear Dr. Parikh, I certainly agree with much of what you said. However, you appear to be unaware of several aspects of the Kaiser Electronic Medical Records system. You say “Wow. I’ve just taken care of three patients in 12 minutes, and I didn’t do it by “churning” them through my office as if it’s some sort of factory assembly line. Rather, those patients (their parents, more specifically — I’m a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms……In the… Read more »

Louise Page
Guest
Louise Page

I’m all for new methods of health care. I’m very close to not caring how much a doctor would charge. My problem is FINDING A DOCTOR to help take care of my grandchild who has a mental illness. Have any of you bloggers ever spent hours or days in an emergency room, only to be told there are no beds for your child. It would be better if the child had a medical problem; then the doctors would crowd around the bed trying to help. If anyone has any answers for me, please — I’m open to suggestions. signed, desperate… Read more »

Jim Bertsch
Guest
Jim Bertsch

Looks lie doctors are beginning to get out of the pre-information age era. They still have a long way before they arrive. This will be a major part of health care reform. The future is starting to take hold.

Deborah Leyva
Guest

Rahul, Thank you for writing this post. I am excited to hear that care for your patients has improved with the use of electronic records. So many have voiced concerns that implementation of EHRs will require additional time by providers for delivery of care, or that the costs for implementation of EHRs outweigh the benefits, or even provider’s apprehension about interaction with their patients digitally. Although HIPAA Privacy and Security Rules for EHRs (as part of the HITECH Act) have been “greatly enhanced” with the potential for increased enforcement, I believe that in the long term (as we become more… Read more »

Nate
Guest
Nate

Rahul and Doug what are the legal requirements of providing medical care via email? I have been trying to install telavisits into limited plans for lower paid employees and would think email would be a step up from that, webcam and sending pics would have to help. What would you bill these out as $ wise? Tela we can get for $35 which is a great deal, specially for single parents with lots of kids who don’t have the time, or even the transportation to get to the Dr. Plan I am working on now we pay the full cost… Read more »

R Watkins
Guest
R Watkins

Diagnosing and treating by telephone has always been considered bad medical practice. But now, if we do it via e-mail, it’s considered good?
Are quick, convenient, and cheap to be the ultimate standards by which we judge the quality of medical care?

Dr.Rick Lippin
Guest

I strongly favor e-health records. But I have grave concerns about tele-medicine (with some notable exceptions like military or other geographically distant patients)
The tele-medicine advocates need to carefully study the the literature on the merits of face to face(flesh time)interaction. Much transpires(measurable)which cannot be duplicated electronically.
The excesses of tele-medicine could spell the end of the doctor-patient relationship and medicine at its very best.
Dr. Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

Doug Arnold
Guest
Doug Arnold

Dr. Parikh, Enjoyed your post. I am the CEO of a large physician network in CT. There were four new CPT codes for 2008: 99441 PHONE E/M BY PHYS 5-10 MIN 99442 PHONE E/M BY PHYS 11-20 MIN 99443 PHONE E/M BY PHYS 21-30 MIN 99444 ONLINE E/M BY PHYS Unfortunately, in my state (CT) hardly any of the large healthplans will pay for these codes, even though Medicare pays for 99441-444 in 2009 ($15-$41). It is hard to get physicians to adopt new modes of patient care if they are forced to make large investments in technology with scant… Read more »